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03/09/04 14:17 UCD CI1 & ENV ENGR 4 912094640138 NO.855 DC, <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> EN`YIRONMYNTAL HEALTH DEPARTMENT <br /> u A Ill�J 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> MAR 9 2004 (209)468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.us/ehd 007 4� 4 <br /> ENVIR PUBLIC RECORDS RELEASE APPLICATION <br /> PERW;6&.VIC�lY Ader'rd,• BUSINESSIAGENCY:� `1" Aloe_ <br /> ADDRESS: (-i 1 O Ot Aec S,t CA IS-Z 19 <br /> PHONE: 116- 80Z- FACSIMILE: A41AA- 1 /' <br /> TENTATIVE'APPOINTMENT DATE: l k^"^5'!R'11 I I Time: <br /> (Please allow 10 businoss days from data of application submittal) + <br /> CHECK BOX TO EXPEDITE REQUEST- 3.0� E- QUE PROCESSEO IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 0 <br /> Departmeru Use Only <br /> FILE ADDRESS UNIT <br /> M ❑ Unit 1 AO <br /> P.I saes/ 1353.1 e AA-:m, Clr s <br /> 5. See'' ° ❑ Unit 2 <br /> 4. sees cr <br /> S. sbam aty <br /> 6. Semi G1 <br /> t. saner aly tUnit <br /> e. saeel My <br /> at <br /> 10. weal Gl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> eUNOERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT G SOLID WASTE FACILITY <br /> -8'OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY D SOLID WASTE VEHICLE <br /> •e•UNDERGROUND TANK(MONITORINGfREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> o'HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT " <br /> 17 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CLETS <br /> O TATTOOIBODY PIERCING ❑ POOUSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <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. Ex 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 /> 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> E►+n�ea�aos <br /> uenam <br />