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_7077483 CERES ASSDCIATEF -- PAGE 01 / 011�(l <br /> IE <br /> 11 ECEIVEO ENO LOG NUMBE0. / \ <br /> SANJOAQUIN COUNTYPUBLIC. HEAI..TH SERVICES <br /> Ut (o 1 9 2005 ENVIRONMENTAL HEALTH [DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR qo <br /> ENVIRONMENT HEALTH STOCKTON CA 85202 /v' <br />! PERP,IIT/SERVICES (209) 468-3420 <br /> PUBLIC RECORDS RELEASE. APPLICATION <br /> AP n f .. Pe5 . Assouec+es <br /> ,� � BUSIN <br /> Muer +t �e E55lAGENCY Ge <br /> I aDo Ess 2 � ' 5t reet . ' geni (444 , r/I 1510 <br /> pHoNe 17g7) FACSIMILE <br /> 1 TENTATIVE` APPOINTMENT DATE 11310 (0 77ME 10AA4 <br /> (Ploast giV¢ 7 to 10 business days from date of application submitfaq <br /> I� CHECK SOX TO EXPEDITE ReMEST - $7$.00 FLEE- REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 51GNATURE OF APPLICANT _ . ! ° ��G�l��_ DATE � � ' ��l A; 5 <br /> i <br /> p FILE ADDRESS ` THIS SIDE EHD STAFF USE ONLY <br /> _ I p z Lower 5acrLrmenft tialo n � PROGRAM ELEMENTS SEARCH <br /> I /' G� r+ Cn fD �oCCat/ $ fDr1L FWL o� <br /> 1 <br /> I . ) <br /> ri <br /> I <br /> i <br /> - I ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP slaM (NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VBHICI.E <br /> UNDERGROUND TANKiMONITORINGIR:MOVAL) ❑ D011 KENNEL G1 DAIRY <br /> HAZARDOUS wAsTE. GExSP64,TM O CHICKEN RANCH . O PKO TREATMENT PLANT <br /> TIERED PERM rlEP FACILITY d MOTELlHOTEL O PUMPER TRUCK7YARDICHEM TOILETS <br /> T'ATrOO1aODY PEIRCING 0 POOUSPA ❑ LAND USE APPLiCA7tON SITES <br /> fib MEDICAL WASTE FACILITY 01 PUBLIC WATER SYSTEM O OTHER (PLEASE SPEG(FY' ABOvE) <br /> 1 . List up to ten addresses in the space above. Select the type(a) of files from the .ltst above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax tp(202) 484n0138 or trail to the <br /> addmPg indicated above. <br /> 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 /> i will be held for a maximum of five business days far review. Appointments should be scheduled <br /> accordingly. <br /> A file that is actively being worked an by EHD staff may not be immediately available for review. • A new <br /> I application may be submitted when the file is available, <br /> 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 MmOD deposit prior to review. <br /> 5. •TENTATIV'c appointment dates must be confirmed with END staff. <br /> 4. Applications rec0ivodl after 3.00 pm will be processed the (Text business .day, <br /> I v <br /> ONFIRMED APPOINTMENT DATE TIME <br /> LATE CONFIRMED PHON5 FAX INITIALS <br /> EVIEWED YES NO REV1115W. DATE <br /> aG id a Ida — . ._ . .. <br /> " TOTAL P . 02 <br />