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09/06/2005 09:37 2093694228 NEIL ANDERSON ENVIRO PAGE 03/03 <br /> ENO i_OG NUMBER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> EN' VIRONM ENTAU HEAL;M DEPARTMENT <br /> 304E Weber Ave 31d Floor Stockrton, CA 95205 <br /> $GP – G 2��§09) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> 177 <br /> FN`JIFOI440"i, N�AI<Ttil PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> �,h,f _(() BUSINESS/AGENCY <br /> /ADDRESS:, Q{1co_Lt/1(�1� Y\CLl <br /> PHONE: �� l FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 20 Time: <br /> (Please allow 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST•$93.00 P5E=REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,U C�J%Gr{fir _ DATE <br /> Department Use Only <br /> I�1 <br /> 51LE ADDRESS <br /> UNIT <br /> -SN 6� S, �Cl at = o�C t�Ctl► ❑ Unit 1 <br /> t. Sucel �, <br /> l _' n5,-j 1 ' ci <br /> Z. � 'o(Gs ct l t�1!P tY trYr\s I ts <br /> 1pl00 <br /> c <br /> Unit 2 <br /> Simm <br /> Strcrl City <br /> Stm.rt Ls ZUnit 3 <br /> cty <br /> S <br /> 7 cay Unit 4 <br /> a. street r..uy _ <br /> P. Srrr� ctty ❑ Unit 5 <br /> to. street <br /> ci <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> EANDERGROUND TANK(UST)CLEANUP 517E(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FAGILrrY <br /> 13�OTHER CLEANUP SITE(NDN-LOP) ❑ FOOD FACILITY a SOLID WASTE VEHICLE <br /> 1�UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> �AZARDOUS WASTE GENERATOR Q CHICKEN RANCH CI PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTEUHOTEL U PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING Q POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 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) 4640138 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 /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> e�tv2ao� <br />