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:i $ 209-579-2225 M00EST0 ASC <br /> 11 r-- •1' !� PAGE 01 J <br /> V. <br /> SAN JOAQUIN COUNTY E.Ha LOU NUMMIM. <br /> SEP 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> __�!` IRGNM� NT HEALTH STOCKTON CA 9520.2 <br /> PMNI4T!SERU!CES. (209)468-3420 L16 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. � t� Qtr H'1� BUSINESSIAGENCY <br /> ADDRESS ��`� L .Jte. 1w, Ar.72�t 5�7� k- l"1 5� _ 5'D Ct� <br /> PHONE 'L _ FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE `Z Cf] <br /> TIME 07 <br /> (Please glue 7 to 10 bualnesa days from date of application submittal) • <br /> aJ� <br /> CHECK BOX TO EXPEDITE REQUEST-589.00 F E—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> IT <br /> SIGNATURE OF APPLICANT — <br /> V <br /> DATE `t" 311<1:5:. <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> X35 <br /> L <br /> Lk— o,ei rc.. oZ <br /> 2141 1�}qd r:� S n <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> N(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) -C3 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> El OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY. © SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) M DOG KENNEL O DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICIIEM TOILETS <br /> 13 TATTOO/BODY PEIRCING ❑ POOLISPA a LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the apace above, Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one ills type MUST be selected. F x t 0 464-0138 RE M11111 12 the <br /> ad r Indicated ve. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be hold for a maximum of five business days fpr review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately aval[able for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates Trust be confirmed with EHD staff. <br /> 6. Applicatlons received after 3:00 pm will be processed the next business day. <br /> 0ATP.k3er4f.1f u PH E F FNI tAt.8 <br /> I E I? YES NO 41ir t� E <br /> C' /'7 :�m C•( 7Y�� 1172G l 7 <br /> xza:ow <br /> i � <br />