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04/04/2005 15:53 209369y"q NEIL ANDERSON EV 'RO PAGE 02/0 <br /> w' di <br /> GATE RECEIVED k [-HD LOG Nt 1=R <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL H. .EA,LTH DEPARTMENT16 <br /> � i <br /> 304 F,Weber Ave 3d Floor Stockton, �y _ <br /> (209) 4683420 Fal: (209) 464-0138 Web: www.co.sar�-"jt3'a� cakS@d3' 3$ <br /> UMI'Y <br /> PU)31., SAM JO gUN <br /> TC RECORDS RELEASE AP � <br /> APPLICANT; r ` < �� BUSINESS/AGENCY: Ear <br /> ADDRESS: <br /> qL <br /> PHONE: Q"1 DFACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time; <br /> + (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use ON <br /> FILF-PsPDRESS UNIT Lid! <br /> +, street \ ll Z � V J <br /> z. street R-1 fly <,lr.�.ti ga19'h. city r i Unit 1 Z <br /> 3. Street a') V 5 CIS `� _(� 1 <br /> 11't Jj Unit 2 <br /> �. Slrcet a C.- <br /> 5. Street _ chy <br /> .•1 Un' 3 <br /> 5. street —1 0. t •V t <br /> 7. street 'a, (/� + S aw <br /> Unit 4 <br /> o. Street ai • <br /> P. Street _„- City ❑ Unit 5 <br /> 10, Street ci t <br /> ENVIRONMENTAL;HEALTH DEPARTMENT FILES <br /> Ik UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT AV SOLID WASTE FACILITY <br /> ,110 OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Rb UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL ❑ DAIRY <br /> P;b HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH CI PKG TREATMENT PLANT <br /> 10 TIERED PI=RMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILE <br /> ❑ TATTOO/i3ODY PIERCING ❑ POOL,/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of file$from the list above by check <br /> the appropriate box(es)- At least one file type MUST be selected. Fax to(209)464-0138 or mail to tP <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 fill <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 r <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 exper <br /> of the applicant_ Future file reviews by the same applicant may require a$93.00 deposit prior to revi <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 />