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Sent By: LAW OFFICES; 6505668164; Nov 3:07PM; Page 1 /1 <br /> EHD LOG NUM6ER <br /> DATE RECEIVED SAN JOAO,UIN COUNTY V 00 <br /> Lf�(r- (�jC�1����/ I � ) ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 `I L \ 304 E Weber Ave 3 Floor Stockton, CA 95205 <br /> NOV 2 3 2 <br /> }468-3420 Fax: (209)464-013$ Web: vvww.co.san-joaquin.ca.us/ehd <br /> H'NIWAi IENI HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PEf-�PJ1ff/5 ` , «� 0�1���t ♦ �cG�t� K �ccd <br /> APPLICANT: + K B/U�SINES$(AGENCY; L <br /> ADDRESS: .36 n Iq�1Cnv�� Pa�� l 4'0* C!6 9 0 << <br /> PHONE: 6�a ~ 2 f{ - 3 F7 -- FACSIMILE: 6 So 5-�6 Y <br /> TENTATNE`APPOINTMENT DATE: .1J,FCCIn be-f- `i LO o Li Tim.: r O : JO <br /> (Ploaa,@ allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST <br /> PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> -' Department Use Only <br /> �rs.r ar ex v'� ILE ADDRESS UNIT <br /> r. saaec 5-14 S. N'r ( �_ Coy Unit 1 � <br /> c' Qz. satv v� <br /> 9a'4N ❑ Unit 2 <br /> 3. <br /> 4. <br /> 6. saeml c Unit 3 <br /> a. sc�i t <br /> i. s...< <br /> CRY nit 4 <br /> fl. Sa.mt <br /> city <br /> Unit 5 <br /> i0 btn�� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL Cl DAIRY <br /> 9(HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Cl PKG TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 13TATTOOIBODY PIERCING 13POOLISPA ❑ LAND USE APPLICATION SIT=S <br /> ❑ MEDICAL WAST: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 i _ ica�Pd ve. <br /> 2. EFID will notify the applicant If any EHL files exist. An appointment for review will be confirmed <br /> zpproxirnately five business days but no tater than ten (10)days ai er 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 rife reviews by the same applicant may require a $93.00 deposit prior to review. <br /> S. '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 /> DATE CONFIRMED PHONE~ FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 40-02-004 <br /> U�t2009 <br />