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84/15/2004 15:15 20946711 AGE STOCKTON PAGE 01/C <br /> DATE RE>aEIVEb -:' J EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> APR 15 2004 ENVIRONMENTAL HEALTH DEPARTMENT do <br /> 304 E Weber Ave 3`'Floor Stockton,CA 95205 <br /> `s 1 h�2*468-3420 Fax: (209)464-0138 Web: www.co,san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION A <br /> APPLICANT: o BUSINESS/AGENCY: Aa0 .Q CI1 V 1 � L <br /> ADDRESS: . ON 95�2)6 <br /> ® /� <br /> PHONE: Qt.O 7. 7�jQFACSIMILE: W9.• (7 / ~/®® r <br /> TENTATIVE*APPOINTMENT DATE: ff <br /> 1�moll, <br /> (Please allow 10 business days from date of application submittal) <br /> 39 �w <br /> CHECK BOX TO EXPEDITE REQ ST-593.00 FEE—REQUE OCE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATJ!1� j. J G4 <br /> Department Use Only <br /> !�p„� N FILE ADDRESS UNIT <br /> aoa! p . I r <br /> z. sn*arUIZIL E. <br /> p n �s r a+w 1i •7- Cl Unit 1 <br /> 3. .SU" 6 r� M -;0 l <br /> 4. seed >1� n L�ST ss 3 V u ❑ Unit 2 6 <br /> s avd eta a Unit (�j U <br /> e. Sr" 11 ED unit 4 <br /> 9. Strad <br /> +o• s ❑ Unit 5 <br /> C� 901 PR .. / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> r <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY G SOLID WASTE VEHICLE as <br /> UNDERGROUND TANK(MONtTORINCIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKQ TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL C PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING O POOLISPA ❑ 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 Idast 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 fries <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A fie 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. <br /> x" <br /> CONFIRIVIEC�APPOINTMENT bATI .•. TIME: _R <br /> DATE CONFIRMED <br /> PHONE.:. : _ • FAX • IN MALS <br /> REVIEWED .... . YES... NO.- EVIIEW DATE <br /> EHD 4IM-006 <br /> Qr8fM <br />