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il/le/2003 16:30 416401' ENVIRONMENTAL PAGE 02 <br /> EHO LOG NUMUER <br /> SAN JOAQUIN COUNTS <br /> -E+NYiRoNmNTAL IEEEALTH DEPAR''fi`MFNT <br /> NOV 1 344 E Weber Ave Yd Floor Stockton,CA.95205 <br /> 2N9)468-3420 Fax: (209)464-0138 Web. www.co.san-joaquincaus/ehd <br /> fV ERMI fv1t=1V r HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERfv31Tl, c <br /> APPLMANT:, &LdLe' Q0 -6&L4S suSINESSIAGENCY:_ I- [�Ct✓J5 c1�r�s l�`--� <br /> ADDRESS: ZC, C] Ca u-.c"gyp D 1AL OI <br /> HONE: 12-S T S3 Godo }c. !d S FACSIMILE_ l� s <br /> � _Z-`b.3 C-,O <br /> E* <br /> TENTATIVAPA41N mENT DAIS: f 1 1f 17 I(T Time: <br /> IPiaase allow 10 business days from data of application submittal} <br /> Q CHECK BOX TO EXPEDITE REQUEST-39 E I~QUF-ST PROCESSED IN a BUSINESS DAYS <br /> . IGNATUR>"OF APPLICANT DATE _.-1 I-0_03> <br /> beoartmeni Lisa Only <br /> FILE ADDRESS UNIT <br /> t sora Z o r Iv r4 e <br /> z seer -K GL&6� - / '+n,c. kJ-, r,�a ❑ unit v > <br /> 3. ttrre, 23 .S jv <br /> +. ! w'� r L" RJ CI YaG C] Unit 2 <br /> 6. WC-s of— _6"1- S f,­7 �t C <br /> a. t rwi lKv1 'r� S nit4 <br /> B, s+rr-s G <br /> ID. Street p gnat 5 <br /> ENVIRONMENTAL,HEALTH DEPAKTMENT PILES <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT' ❑ SOLID WAS'T'E FACILITY <br /> P-OTHER CLEANUP SITE(NON-LOP) n FOOD FACILITY d SOLID WASTE VEHICLE <br /> r UNDERGROUND TAKK(MOHITORIN©AMMOVAL) B AOG KENNEL Ci D,6jRY <br /> r HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERIYIITTEO FA4;;1Lrry M MOTELIHWEL <br /> C3 PUMPER 7RUCKlYARDIGI MEM TO <br /> E3 TATTOBODY PIERCING 0 POOLISPA t� LAND USE APPLICATION SITES <br /> Ol <br /> ❑ MEDICAL WASTE FACILITY I7 OTHER(PLEASE SPECIM <br /> 1. List up to ten addresses in the space above. Select the types) of MSS from the list above by checking <br /> the appropriate box(ez). At least one file type MUST be selected. f;%X gM9 Aso-0139 cr ma;Ito the 1 <br /> addddress�rldicated_ahove. – . <br /> 24 EHD will notify the applicant if any EHD files exist. Art appointment for review will be confirmed <br /> approximately five business days but 1101ater than tern(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 fife 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 wrote applicant may require a se3.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must he confirmed with EHD staff, <br /> 61 Applications received after 3:00 pm will bo procesSad the next business day., <br /> CONRRMFED APPOINTMENT DATE 2 { <br /> _j TIME <br /> DAtE CONFIRMED PHONE FAX INITIALS'- r <br /> RI=VIEWED - YFES NO REVIEW DATE. <br /> erarmo� I�`!f_7•-U � : �-,J ; � <br /> ('Cr <br /> O t�P.fy?f7'(X <br /> 17c',t La r'P41 U, lt6 11 A s <br /> iI � r (J . � ALeGo / r PP <br /> T9 3E)Vd �- <br /> (d5) SiNvi-inSNOO I9V TZT9£8Z9Z6 bE:LT E00L/0T/1T <br />