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01/20/2004 09:55 4640138 <br /> - ENVIRONMENTAL HEALTH PAGE 01 <br /> DATE RECEIVED �/]j� �/ SAN JOAQUIN COUNTY EMU LUIS Ivulwocn <br /> RE) �� l� EN"RONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> ,JAN 2 1 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S BUSINESSIAGENCY: <br /> r"Z <br /> ADDRESS: � J <br /> PHONE: l lQ `}'— gWC> FACSIMILE: 57, 0 3� q i4 <br /> TENTATIVE*APPOINTMENT DATE: I IIIZ-7 �� Time: ! ` ' 3 <br /> (Please allow 10 business days from date of application submittal) <br /> tg(CHECK BOX TO EXPEDITE REQU �-$93.0 ROCESSED I 3 UUSII}N,EE$S, DAYS <br /> SIGNATURE OF APPLICANT K� ��/�''�''"I DATE Z <br /> Department Use Only <br /> FILE ADDR SS UNIT <br /> I, street ago G ❑ Unit 1 <br /> 2. sly t 5 a3 p1-I <br /> 3. sl"I oty Unit 2 <br /> 4. Stn.•el CI <br /> s. street e' Unit 3 <br /> a. west ° <br /> ON flit 4 <br /> e. avast a <br /> g, sit C, ❑ Unit 5 <br /> in sheet t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 1 ` 0 <br /> 'JIs3 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE Fklbt Y� <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> C<OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> 1744 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> W HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL O PUMPER TRUCK/YARDICHEM TOILETS <br /> b TIERED PERMITTED FACILITY ❑ POOLISPA 1-1 LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY} <br /> 12 MEDICALwASTE FACILITY <br /> ace above. Select the type(S)of flies from the list above ey checking <br /> 1, List up to ten addresses in the sp <br /> the appropriate box(es). At feast one file type MUST be selected. all to the <br /> Fax to 209 464-0138 or m <br /> address Indicated above, ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any END files exist. An app The <br /> approximately five business days but no later than ten (10) days after <br /> erreceipt thou dof pbe lication. <br /> ed files <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. <br /> 3- A file that is actively being worked an by EHD staff may net be immediately available for review, A new <br /> application may be submitted when the file is available. at the <br /> 4. Any file not returned in the same condition as released <br /> will <br /> r ni =a $9 00 dept ed by EHD staff prior expense review. <br /> of the applicant. Future file reviews by the same app may require are <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 d } <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS �— <br /> REVIEWED YES NO REVIEW DATE <br /> Eno an.oz-vos <br /> 91WQ03 <br /> JAN 23 2024 10:01 464013B PAGE.02 <br />