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OCT-19-2004 16:32 HIELD ENUIRONNENTAL - 7043946968 P.01i01 <br /> DATI=RECEIVED <br /> SAN JOAQUIN COUNTY ID EHQ LOG NUMQF.R <br /> • ENVIRONMENTAL HEALTH DEPARTMENT ,J iV,%�;� <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> - (209)468-3420 Fax:(209)_4k4-0138 Web: www.Co.san joaquin.ea.us�hdr "9 2Qp4 <br /> PUBLIC RECORDS RELEASE APPLICATION— ;i�r' 11L:4Lr <br /> APPLICANT: � b 4 1 USINE :/AGENCY: <br /> ADDRESS. + 6 <br /> � e <br /> PHONE: -^- + D <br /> l �i FACSIMILE: C 0 � <br /> TENTATIVE"APPOINTMENT DATE: N _ - .Time- A4 <br /> (Please allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUE:$T UE T R CESSED IN 313USINESS DAYS <br /> w <br /> SIGNATURE OF APPLICANT jDATE . ©4 <br /> [ Partmept Use Only � <br /> :FILE ADDRESS UNIT <br /> 4. Slyest �� <br /> streer '" ❑ Unit 1 <br /> rarer <br /> a. sa..r Cuy _ [] Unit 2 <br /> �. 51" ��y <br /> 5. tsrr"et � � j 0 �Q <br /> Unit 3 1 <br /> city <br /> 7 5V6u1 - <br /> ,. Unit 4 <br /> e. Llm _ _ CIS - <br /> 9. SMMtiI �.. "" ..._.� <br /> to. so-eer � <br /> Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I <br /> La.t. XUNDERGROUNP TANK(UST)CL1C,4NUP&ITE(LOP) M HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY 0 SOLID WASTE VEHICLE i <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) 0 000 KENNEL ❑ DAIRY .I � <br /> 0 HAZARDOUS WASTE(GENERATOR M CHICKEN RANCH IO PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY d MOTELIHOTEL 0 PUMPER TRUCKlYARDICHEM TOILE=TS <br /> 0 TATTOOIBODY PIERCING Q POOI..ISPA 0 LAND USE APPLICATION SrMS- <br /> I3 ME=DICAL WASTE FACILITY ❑ 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 box(es). At least one file type MUST be Selected. Fax to 209 494-0438 Rr mail to the <br /> address Indicated above. <br /> 2, EHD Will notify they applicant If any EHD flies exist, An appointment for review will be confirmed r <br /> approximately five business.days but no later than ten(10)days after receipt of application. The files <br /> wilt be held for a maximum of five business days for review. Appointments should ba scheduled <br /> accordingly. 4 <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 EHG staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. f <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff, i <br /> 6. Applications received after 3:00 pm will be processed the next business stay. f <br /> CONFIRMED APPOINTMENT DATE . TIME <br /> I <br /> DATE CONFIRmw RHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> LHo 4e41-0oa .. _ .. <br /> annoot ( <br /> a <br /> TOTAL P.01 <br />