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��/02/2004 12:09 FAX 20C 80621 U002/002 <br /> DATE RECEIVED crw .., <br /> SAN JOAQUIN COUNTY <br /> if ll L� ll`J l EwmonmNLTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"d Floor Stockton, CA 95205 <br /> MAR 0 2 2004(209) 468-3420 Fax: (209) 464-0138 Web,www.cosan joaq=.caus/ehd <br /> ENVIRUMMEiUT HEA t[H PUBLIC RECORDS RELEASE APPLICATION <br /> PE;�it 2F �r�rE- <br /> I <br /> APPLICANT:_ �► S TP 2Lr, ��BUSINESSIAGENCY: N.,kc� 12 <br /> ADDRESS- `aZ� �- M`(tZ-,�.E S'10 <br /> PHONE'- -_��^t --�'��{�` FACSIMILE: <br /> I� <br /> TENTATWE*APPOINTMENT DATE: 3"j[ o y Time: I IUD <br /> 9 (Please allow IQ business <br /> days from date of appli,=iion submittal) <br /> �i <br /> CHECK 13OX TO EXPEDITE REQUEST-$93.00 FEE—REOVEST PR ED IN 3 BUSINESS DAYS <br /> �. 11 <br /> SIGNATURE OF APPLICANT DATE 312J 0 L <br /> DeoatTwrt Use Onty <br /> FILE ADDRESS UNtr <br /> i. s V-D 3-1. L,00 p Unit 1 <br /> 2_ Street v 1 av tA ` <br /> z. Succt �°1 S �fl <br /> L <br /> Ips Q Unit 2 <br /> 4, Street I r ' 1,.+0 <br /> s. sheet <br /> P' Unit 3 <br /> 7. st,ee r L o S~. U . 4 <br /> 1-7" .Z9 /bL 4ti0 <br /> 9. Stitt I, <br /> 1Q. SErel <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4V UNDERGROUYD TANK(UST)CLEANUP SITE(LOP) L1 HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> 1:OTHER CLEANUP SfTC(NON-LAP) ❑ FOOD FACILM ❑ SOLID WASTE VEHICLE <br /> $UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL 4K DAIRY <br /> fir HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH N"J PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILM ❑ MOTEL110nI, ❑ PUMPER TROCKNAPINCHEM TOR= <br /> ❑ TATTOO/BOD PIERCING Cl POOUSPA 1' LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY El OTHER"_ASE SPECIFY) <br /> 1. LE <br /> ist up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD,will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> appSoxlmately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. . <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. An file not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of applicant. Future file reviews by the same applicant may require a$93,00 deposit prior to review <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> ,00 FIF MI D'MP91NTMEci'bXT TIME <br /> :=DATE.CONVIRMED r v - <br /> �I PHONE _ FAX" ::�- 1NfTIALS <br /> REVIEYVFD i YES NO REVIEW DATE. <br /> Eto I4-02-004 <br /> ernrzao� I� <br /> f, <br />