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r <br /> 08/03/2004 14:01 2094671118 AGE STOCKTON PAGE 02/B? <br /> DATE RECEIVED EMD LOG NUMBER <br /> SAN JOAQ><]IN COUNTY <br /> T�ELg <br /> I�3NVII20Nl4�NTAIH�AI TH DEPA,RTViENT <br /> E Weber Ave 3 .Floor Stockton, CA 95205 jq431 <br /> AUG (600 43420 Fax: (209) 464-01138 Web: www.eo.sarl joat)uAn.ea.us/ehd <br /> FNV1RQ1WLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �} n BUSINESSIAGENCY. <br /> ADDRESS: <br /> PHONE; - FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE; 12oL4iit119. <br /> (Please allow 40 busfnass days from dote Of appliratlon submittal] ` <br /> CHECK BOAC TO EXPEDITE REQUE 93.00 PEE--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE 3rA-1_OryWD <br /> Department <br /> FILEADDRESS UNIT <br /> 2- Street "' t� Unit <br /> 3. StrnM C � :Ly�w <br /> .. et�t y ❑ Unitca <br /> f <br /> 6. Stroet CII C_. <br /> 1 <br /> e. stra,c - nit 3 <br /> 7. slrcct CR <br /> a. stroet nit 4 <br /> C!. <br /> 6. sued. <br /> 7D. stmdn CAX Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT 17 SOI.f!]WASTE FACIL fTY <br /> OTHER CLEANUP SITE(NON-LOP) 4 FOOD FACILITY a SOLUS WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG FACILITY <br /> G DAILY <br /> HAZARDOUS WASTE GENERATOR C CHICKEN RANCH 0 PKCy TREATMENT PLANT <br /> TIERED PERMITTED FACILITY D MOTELlHOTEE Ej PUMPER TRUCKIYARDICHEM TOILETS <br /> 1O MA131CAL AS E FAC NG f] POOLJSPq 117 LAND US E;APPLICATION SITES <br /> OI MEDICAL WASTE FAC I� 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. Fax to 209 464-0138 o mail to the <br /> Address indicated above, <br /> 2. EHD will notify the applicant if any EHD files exist. An a <br /> ppolntment for review l be confirmed <br /> approximately five business days but no later than ten (0)days after recti pt of applicat on, 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 itttmediately available for review. A new <br /> application may be submitted when the file is available. <br /> a• Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant, Fatt-Ire file reviews by the same applicant may require a$93,00 deposit prior to review, <br /> 5• <br /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3,00 pm wilt be processed the next business day. <br /> FCONFIRIMIIED APPOINTMENT DATE <br /> - TIME <br /> r DATE CONFIRMED <br /> REVIEWED PHONE pqx <br /> INITIALS <br /> YES NO REVIEW DATE <br /> �tD 48A2 5 <br /> a/913D03 <br />