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OCT 21 2004 11:40� T' 094640138 P.01i01 <br /> 11•44 lid ENVIRONMENT rEALTH PAGE 01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> r�!' E+NVMONMNTAL HEALTH DEPARTMNT <br /> J� 304 E Weber Ave 3'1 Floor Stockton,CA 95205 0010 200Q209)468-3420 Fax, (209)464-0138 Web:www.co.san joaquin.ca usland Z <br /> 0 -N-1. N� c PUBLIC RECORDS RELEASE APPLICATION <br /> ECa r t1tT!�,:n rla� J �C BUSINESWAGENI— . <br /> �adLICANr: CY: <br /> ADDRESS- Ave . SU'k a I <br /> PHONE: r o) 376 -tf3 C I FACSIMILE: S 0 f-34 -767 <br /> fro If34f'`{ ;91-b0 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Pleas*allow 10 bushes*days from date of apgl)c*00n aubrill") a <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST P SED IN 3 BUSIK*Mo tl g'a• <br /> SIGNATURE OF APPLICANT T.DATE <br /> G a 0 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> sm ) 'f L V . ❑ Unit 1 <br /> ��� z S� gvo '� r•t'c � aft :;� �. <br /> a sem 3 -f V o e n C �( ❑ Unit 2 <br /> o Unit 3 <br /> 6. 9veM <br /> a, S,ee <br /> Unit } <br /> 7. 56ee1 <br /> s swa u ❑ Unit 5 <br /> 10. meet •:q <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES s€r <br /> UP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE•FACILlTY <br /> �p,{�NDERGROUNO TANK(LIST)CLF1W <br /> E3 FOOD FACILITY D SOLID WASTE'VkHIC <br /> �OTHER CLEANUP SITE M�'LOP) ❑ DOC KENNEL 0 DAIRY ' <br /> ,UNDERGROUND TANK(MONITORINGIREMOVAL) C) CHICKEN RANCH U PKO TREATMENT PLANT <br /> .WL'ARDOUS WASTE GENERATOR O MOTEUH07E1. 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TIERED PERMITTED FACILIT' FOOIJSPA 0 LAND usE APPUCA710H SITES <br /> O TATTOVmODY PIERCING aOTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACILITY <br /> 1, List up to tan addresses In the space above, SeU�6e�ected f Fles from ax to{209)a list 10 above by mal a th®g <br /> the appropriate box(es). At least one file typeM <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist An appointment for review will be confirmed flies <br /> approximately five business days but no later than ten(10)days after receipt of app <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 EHO staff at the expense <br /> of the applicant. Future file reviews by the some applicant may require a$93.00 deposit prior to review. <br /> 5, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6, Applications received after 3:00 pm will he processed the next business day. <br /> C,Ot4FIRMEO APPOIN.MENT.DATE TIME <br /> DATE CONFIRMED 'PHONE• FAX INLTIHLS <br /> 'REVIEWED YES NO REVIEW DATE, <br /> OCT 21 2004 1121 * TOTAC PAGE.01 ** <br />