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OCT 21 2004 11:40 TI#194640138 P.01/01 <br /> ENVIRONMENT NLTH PAGE 01 <br /> - EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH pEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 h <br /> OCj 1 200209)468-3420 Fax- (209)464-0138 Web:www.co.sall Joaquin ca uslehd v <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 77 . <br /> �C ' �11�I'"n Si an S I "zal< BUSINE551AGENCY: •—_—^"" <br /> draLICkNT: 5- k a)A o I <br /> ADDRESS: If-?O -3 <br /> PHONE: to) 376 -rf3 b I FACSIMILE: S(0 Lf'14 "'7 6 7 <br /> 5(o 3`f-9 a b o Time: <br /> TE ATtVE•APPOINTMENT DATE: <br /> gs (Pleaw allow 10 buslnesa days from data olapptkatlw+submroal) •!" <br /> f ' � <br /> CHECK BOX TO EXPEDITE BEQUEST•f9S•00 -REQUEST P SED IN 7 BUSIN114P ^ O <br /> F 6 <br /> 0ATE <br /> $IGNATUREOFAPPLICANT w DecaryneMUse only <br /> V 71 ;'A <br /> FILE ADDRESS <br /> ��5,�"� i. sn 1 q n fC I 'I !..'�l"Sx snagO"0 5f'2G 'E c <br /> i,. wan G I suo. <br /> 10 Sp l <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> D SOLID WASTE fACIA <br /> NDERGROUNO TANK(USn CLEANUP S"(LOP) O HOUSING a FOOD FACILAaATITY <br /> ENT O SOLID WASTOVkHlCL , x <br /> tui <br /> THER CLEANUP SITE(NOH-LOP) ❑ DOG KENNE ❑ DAIRY -.. .•+ <br /> NDERGROUNDTANK(MONrTORINGIREMOVAL) ❑ cHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> X HAZARDOUS WASTE GENERATOR O MOTEtJHOTEL ❑ PUMPER TRuCKfYARDICHEM TOILETS <br /> O TIERED PERIVIneD FACILITY O POOUSPA U LAND USE APPLICATION SITES <br /> ❑ TATTOO190DYPIERGING ❑ OTHER(PLEASE SPECIFT) <br /> ❑ MEDICALWASTEFACILrtY ehe0ing <br /> q- List up to ten addresses In the space above. MUS the typese of files from the fist above by <br /> the appropriate box(es). At least one flit type MUST he selected. Faz to 209 464 0138 of mall to'he <br /> address Indira ed above. ointment for review will be cordirmed <br /> 2. EHD wilt noti theapplicant If any EHD files exist An app <br /> willll be hold for fie business das but no later thin avmaximum of five business days for erevi w. Appointments shouldbeschcduledflles <br /> accordingly. <br /> 3. A the that is actively being worked on by EHD staff may not be immediately available for review. new <br /> application may be submitted when the file is available. <br /> d will be 4 tithe applicant Future Eller Views bytion as releASS the same PPf�nt may requ re a$93.00 aniled by Hdeposh prior to expense <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 /> C,0NF1RMEb APP0INFMENT PATE = TIME <br /> DATE CONFIRMED <br /> PHONE.:" FAX' INLTIAIS . <br /> 'REVIEWED YES NO REVIEW DATE <br /> OCT 21 2004 11:21 �- - TOTRL PAGE.01 ** <br />