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06/03/2004 10:24 2094671118 'AGE STOCKTON PAGE 01/1 <br /> END LOG NUMB <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> (� t�—s j���� ENVIRONMENTAL HEALTH DEPARTINVENT <br /> HEMP/ <br /> 1/ l_DD 304 E Weber Ave 3"a Floor Stockton,CA 95205 <br /> �U� 0 3 2��Q9)468-3420 Fax; (209)464-01.3&Web.www.co.san-joaquin.ca.us/ehd <br /> 4 pU]B IC RECORDS RELEASE APPLICATION <br /> A9 BUSINESSIAGENCY: <br /> ADDRESS: L•R-•-` J <br /> PHONE:__0?- Zk7-1406! FACSIMILE: I I�I <br /> _/V <br /> , Ji <br /> TENTATIVE"APPOINTME14T DATE: _J Ves UA 42 _ -TI'S: , <br /> (please allow 10 business days from dao of application submMar) <br /> /A an y0M neaay..f. . <br /> CHECK BOX TO FJ(pEp1TE REQUES -S9 .00 FEE-RE4UEST ROC Eq IN BUSINESS pAYSJ� <br /> SIGNATURE OF APPLICANT <br /> DATL/ <br /> artmeni Use Orry <br /> FILE ADDRESS UNIT <br /> ,. suaer �N-Witsc 1�t !Qa L ❑ Unit 1 <br /> • mI S"91tf (� c <br /> S"91 ezL <br /> _t Unit 2 1 <br /> not D LJ C-2 <br /> f c Wt _ Unit 3 <br /> /V a! s, see tt LO s e� <br /> r. seeet E.A e-Trm-An (irte a C O 05Un>it <br /> �,� a <br /> 6. Sfi?eS - <br /> Unit 5 <br /> Cl <br /> ,o. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fHU <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMVNT C1 SOLID WASTE CILi F 'r <br /> TH> R CLEANUP 57 IT <br /> (NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> DERGROUND TANK(MONITORIKciREMOVAL) 0 DOG KENNEL 17 DAIRYA7ARDOUASTE GENERATOR 0 CHICKEN RANCH PKG TREATMEkT PLANT <br /> IERED PERMfTTEO FACILITY G MOT>;LIHOTEL Q PUMPER TRUCKlYARDlCHEM TOILETS <br /> L7 TATTOoreoDY PIERCING 0 POOLlSPA LAND USE APDL cATloN SITES <br /> 0 MEDICAL WASTE FACILITY Q 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 boxes). At least one file type MUST be selected. Fax to 209 401i 138 or mail to the <br /> address indicated above. 11 <br /> 2. EHD will notify the applicant if any EHD files exist An appoin"ent 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 /> G. Applications received after 3:00 pm will be processed the next business da Am <br /> CONFIRMED APPOINTMENT DATE : TIME may. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NQ REVIEW DATE <br /> rMV s-om <br /> - j <br />