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v <br />DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVMONMENTAL HEALTH DEPARTMENT <br />O G T 2 7 2004 304 E Weber Ave 3'O Floor Stockton, CA 95205 <br />'3. <br />(209) 468-3420 Pax: (209) 464-0138 Web: www.co.san-joaquin.ca.us1chd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �.Jt7`�p ����" BUSINESS/AGENCY: <br />ADDRESS: <br />TENTATIVE* APPOWMENT DATE: .. (k 10 014 -TIM0: •0 <br />(Please allow 10 businew days from date of app! sub►nktal) <br />13 CHECK BOX TO EXPEDITE REQUEST - #3.00 Frf — REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF DATE <br />►<,rt <br />ENVIRONMENTAL. HEALTH DEPARTMENT FILES <br />UNIT <br />❑ Unit I. <br />Unit 3 <br />Unit 4 <br />❑ Unit 5 <br />&)A 0 <br />W- I <br />0 <br />AUNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT iI(SOLID WASTE FACILITY <br />�C OTHER CLEANUP SITE MON4.M q FOOD FACILITY 13 SOLID WASTE VEHICLE <br />RL <br />UNDEWAMUND TANK (MONiTORINGIREMOVAL) IM DOG KENNEL o DAIRY <br />WWAMOUS WASTE GENERATOR j0 CHICKEN RANCH )I PKG TREATMENT PLANT <br />TIERED POWITTED FACILITY M MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br />I3 TATTOOMODY PIERCING El POOLISPA 1K LAND E APPLICATION SM <br />13 MEDICAL WASTE FACILITY (0 OTHER (PLEASE SPECIFY).1,12,12 g-., <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. Lax to (2091444138 or mail to the <br />address indicated above. <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 files <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 applicant may require a $93.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />a. Applications received after 3:00 pm will be processed the next business day. <br />66NFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX iNITLAL.S <br />REVIEWED YES NO REVIEW DATE <br />END 494U4M <br />Td WdsZ:TO 170OZ zZ '100 P866 828 6OZ : 'ON SNOHd stsFjeLju oaaz iu^O-10 : WOad <br />