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APr .21; 2004 1 15P -uei 1' 0. Anderson & Assoc. - No.4929 LT 2''"."MUL <br /> HATE Ke=�ttv�U SAN JOAQUIN i OUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - ' ' %_.I_ I''`rI V 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> , <br /> (204)4688-3420 Fax: (209) 464-01.38 Web: vrtvw.co.san-joaqU'in.ca.us/ehd <br /> App 2 7 Z004 I <br /> t :3BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: " BUSIINESSIAGENCY: fie V • S6ri '� Fs�SdC , <br /> PHONE: 3[0-4 -340 , FACSIMILE: 3vi _ <br /> TENTATIVE"APPOINTMENT DATE: � I Irk`T Time: j <br /> (Please allow to twsiness days from date of application submittal) <br /> I <br /> CHECK BOX TO EkPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use Only i <br /> FILE ADDRESS UNIT <br /> 3`t0 Cin at d ❑ Unit 1 <br /> ,. stre<t S <br /> 2. S6ree1 NV-t- <br /> 94 <br /> 3`12` C -�v;i cit <br /> a. Sheet /94 �t • ❑, Unit 2 �+l� <br /> 4. Street t] V'e.. f ,�'e-• f" � P r t J J � I <br /> � <br /> 5, street S Gk�!-avt Unit 3 � y? <br /> G <br /> G. street <br /> rao Unit 4 <br /> 7. Street I <br /> 8, Street <br /> Ci ❑ Unit 5 <br /> I <br /> S. Sweet <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT a SOLID WASTE FACILITY <br /> 4A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLI D WASTE VENICE@ <br /> 10 OTHER CLEANUP SITE{NON-LOP) <br /> UNDERGROUND TANK(MONlTOR1NGlREMOVAL) {] DOG KENNEL 13 DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTELtHOTEL ❑ PUMPERTRUCK/YARDICHEM TOILET: <br /> TIERED PERMITTED FACILITY 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO18ODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by checkil <br /> st one file type MUST be selected. Fax to 209 464-0138 or malt tO thl <br /> the appropriate box(es). At lea <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed i <br /> approximately five business days but no later than ten(10) days after <br /> f application. <br /> scheduledtion. The f file . <br /> will be held for a maximum of five business days for review. Appointments should <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be irnmediately available for review. A r <br /> application may be submitted when the file is available: i <br /> HD staff at the exper <br /> 4. Any file not returned in the same condition as released will be reorganized by E <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to rev . I <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. j <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> _ <br /> REVIEW>wD YES NO REVIEW' DATE <br /> EHD 48-02-006 - <br /> 11812003 <br /> �f <br />