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MAY, 18. 1004— 2.08PM "'INTGOMERY WATSON -- NO. 923EHDLP. (UMBER , <br /> DATE RECEIVED %mile SAN JOAQUTN COUNTY � <br /> I-I!\j UN VIRONIKENTAL HEALTH DE�ARTMEN'Z <br /> 304 E Weber Ave 3=d Floor Stockton,CA 95205 <br /> 1 8 2 <br /> M AY %)468-3420 Fax; (209)464-0138 Web: www.co.san-joaquin-ca.us/ehd <br /> -T1V!R:JNN1ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> 1l!t7n,4 IT/SP RVI <br /> BUSINESS/AGENCY: <br /> APPLICANT: v <br /> ADDRESS: <br /> PHONE:( 6 1 ZV� �g�y FACSIMILE: j569" 7-S <br /> i <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> I <br /> (Please allow,10 business days from date of application submittal) <br /> In CHECK BOX TO EXPEDITE REQUEST-$93 00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> PATE O <br /> SIGNATURE OF APPLICANT Departm nt Use only <br /> UNIT <br /> FILE ADDRESS <br /> ,. s 3 K �rf��✓i c o✓1 0'� ❑ Unit 1 <br /> {� G <br /> 2. s CAUnit 2 (7� <br /> S � c' <br /> a. Nn. ('I <br /> o <br /> a 1 3 �. <br /> c <br /> �+ d <br /> -s. sweet � Unit <br /> 7. sit 1-70o D <br /> ' s. seaet atunit5 <br /> ��? O J <br /> 0, sweet <br /> Gt <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NG ABATEMENT ❑ SOLID WASTE FACILrrY <br /> $f UNDERGROUND TANK(U ❑ HOUSING(UST)CLEANUP SITE(LOP) ❑ SOLID WAM�ICLE <br /> t3 OTHER FOOD NG A AT OTHER CLEANUP SITE(NON-LOP) 0 DOG FACILITY <br /> AC(I p' DAIRY <br /> IIS UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0.HAZARDOUS WASTE GENERATOR p CHICKEMOTFUN RAN ❑ PUMPERTRUCKIYARDICHEM TOILETS <br /> t3TIERED PERMITTEb FACILITY p POQUSPA A LAND USE APPUCAI tON SITES <br /> CI TATTOOIBOr)Y PIERCING ❑ OTHER(PLEASE SPECIF"1� <br /> ❑ MEDICAL WASTE FACILITY <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(OS). At least one file type MUST be selected. Fax to (209 464-0138 or mai{to the <br /> address indicated above. ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. to aFP P application. The files <br /> approximately five business days but no Inter than ten(10)days ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3, A file that is actively being worked on by EHD staff may not be immediately available for review. � <br /> n® <br /> application may be submitted when the file is available. at the <br /> 4. Any file not returned inf'same <br /> b condition the same applicant will be may require za$93.00 ded by eposit prior to expense <br /> ew <br /> of the applicant. FutureY <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 /> v+ �� ," :C <br /> ' �I � st I'' .,kr '• • •�'', " �' �+' , r'r' w",�' <br /> Li <br /> P vel*... ° M' !'•' ,��, n'. i "� t, + �1 <br /> r'D l l+�i�1Y lrEIYI IG •.r' r ' '✓'Z 5 rIt <br /> 1,SIF . 77 <br /> 1r% �' .:�_• M' ..'�i,. 7'^. / <br /> RE�f11=WAD ..r:. ATF <br /> N� t <br /> E}t0 48-02.006 <br /> 9!02003 <br />