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04/15/2004 15:15 20946717 AGE STOCKTON PAGE 01/e <br /> DAtE REOIVfb�_' EHDLOG NUMBER JoAQulrt COUNTY . <br /> APR 15 2004 ENVIRONMENTAL HEALTu DEPARTMENT <br /> 304E Weber Ave 3`d Floor Stockton,CA 95205 <br /> Hkt&�468-•3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca,us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (� e,' BU9tNESS/AGENCY: n[Qa ClE7JCIIIJI 601h <br /> ADDRESS+� 4 K/M (/&7 <br /> ry <br /> PHONE! Qf .Q 9. yin . 1,666 FACSIMILE: • 1 / ~/®® �R s <br /> TENTATIVE*APPOINTMENT DATE: irroa: *+ dr&Iterem <br /> /Or 01011. <br /> (Please allow 10 business days from date of application submittal) <br /> w R <br /> CHECK BOX TO EXPEDITE REQ ST-$93.00 FEE—REQUE OCE SED IN 3 BUSINESS DAYS E . <br /> SIGNATURE OF APPLICAN DAT '04 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> trvol MAD Al. V1 ®AM4 K7 V76 <br /> ®� C] Unit 1 <br /> 2. S"M a Q n `�j 1cl�* J I® <br /> Unit 2 � <br /> .. S Winn (AST ss 3 v v Q l <br /> s aea 1,15, <br /> b Unit <br /> e. scent Unit 4 <br /> 9. Sheol lull <br /> ,c s ❑ Unit 5 <br /> - � Pr � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> e <br /> UNDERGROUND TANK(UST)CLEANUP SITZ;(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY G SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN CH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOBODY PIERCING 0 POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL 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)464-0138 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 /> 6. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. s <br /> f. <br /> CONFIRMEEE APPOINTMENT bA7E... TIME: <br /> DATE=CONFIRMED PHONE.: . FAX (NITfALS <br /> ;. - <br /> REV OWED .._ YES... NO-.- -- <br /> RL .;W DATE :.. .. . <br /> EHD 48-0Z�6 <br /> (tf8120W <br />