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11/25/2003 16:12 20446711 AGE STOCKTON PAGE 01/0 <br /> L. <br /> DATE RECEIVED RECEIVED (� - rf 1 - EHD LOG NUMBE <br /> D)Ir � MIS �� U SAN JOAQUIN COUNTY F� <br /> -- 1= ENVIRONMENTAL HEALTH DEPAR'T(MENT _ <br /> N 0 V 2 5 20 304 E-Weber Ave 3rd Floor Stockton, CA 95205 <br /> 209)468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquzn.ca.us/ehd '�� <br /> l:1W pNMEN7 HEALI H E <br /> PlUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �) (BUSSINES/S'IAAGENCY:•�/�f+CCt O'eC1fnll;rQIIrirG( <br /> I+, ADDRESS; �p7Sp W QQ JL�CIC L� nh <br /> PHONE: _ IXo7. '7� (QD� FA)CSSI,.M�ILE: CI 1161, /// <br /> TENTATIVE'APPOINTMENT DATE; WCV 3 P_ W0 _Time; . �ar �Qa4 <br /> I (Please allow 10 business days from date of application submittal) <br /> k I <br /> CHECK 13OXTO EXPEDITE REQU T-$93.00FEE-RE/p/U�/¢T ES IN U INE33 DAYS <br /> SIGNATURE OF APPLICANT W , DATE <br /> Deoanment Use Only <br /> FILE ADDRESS NIT <br /> 1. a"el p <br /> 2. Slm t Q. M / - G Unit 1 <br /> 3. D a <br /> sncal Unit 2 <br /> C 8veet Vl ❑ sh � <br /> s. sl.alW nnam <br /> ❑ /' t�'J 1 <br /> 7. slmel I : l ci <br /> Unit 4 a <br /> 9. Slrcet „ G <br /> 9. Slrtel - p <br /> nit s <br /> 10. Sircei G ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A �,+ ,_ 's <br /> BATEMENT <br /> CISOLID WASTE FA I-Ii4 <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY k ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY i ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING . ❑ POOUSPA ai ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY). <br /> r <br /> 1. List up to ten addresses in the space above. Select the type(s) of flies from the list above by checking <br /> I the appropriate box(es). At (east one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicatedabove. - <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The riles <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 applicantmay 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 be processed the next business day. <br /> � <br /> CONFIRMED APPOINTMENT DATE i <br /> TIME <br /> DATE CONFIRMED PHONE 'FAX', INITIALS, <br /> REVIEWED YES NO REVIEW DATE <br /> eno+aa2aoa ' <br /> ererzaoa '� ' <br />