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OG/25/2004 13:52 2094671118 - AGE STOCKTON - PAGE 01/0 <br /> • <br /> DATE RECEIVED EHD LOG NUMBER <br /> 11 <br /> SAN JOAQUIN COUNTY <br /> �L-"� j ������� � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> JUN 2 5 20 <br /> a09)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIROf4MLiJT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: HUSINESSIAGENCY: 1 <br /> ADDRESS: A OQ nay 6 <br /> PHONE: O7 ` FACSIMILE: f/1 <br /> G�f�(Ii r11 TENTATIVE*APPOINTMENT DATE: . �O.I1111� D7. Time: :d✓ ��er <br /> (Ploase allow 10 buslnass days from data of application submitt34 <br /> 4 k;7 Eq <br /> CHECK BOX TO EXPEDfTE REQUE - 83.00 FEE—RE UEST PROCESSED�N�3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT c .t[ Sfi1 .�'0 7 l �L DATE _�4r/40 y <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t Guhw112,295- QC c <br /> L3 Unit 1 <br /> z. swm a N o <br /> 3. se*et 4) . U& _ cn J1? Unit 2 <br /> 4 Ghent -_7 <br /> 6. s•�a� D $ cn �/ Unit 3 <br /> 6. suave _ <br /> i' $08e1 " Unit 4 <br /> 6 sI <br /> CHY <br /> 9. StreelOy <br /> nl 5 <br /> o. svauechy <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP 517E(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP S1TE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE, <br /> 1UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL LlDAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH E3PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOfHODY PIERCING ❑ POOU$PA fid.LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIF1� <br /> 1. List 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 /> approximately 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. 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$93.00 deposit prior to review, <br /> S. *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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ENO 18-02-008 <br /> 6rLN109 <br />