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09/15/2005 10:53 530676E^'5 STRATUS NO CALIF PAGE 01/01 <br /> 05/11/2004 14:50 4640138 ENVIRONMENTAL HEALTH PAGE 61 <br /> r tr1U LUV NUMOCM <br /> 11 1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT q?& <br /> StI' 5 L005 304 E Weber Ave 31 Floor Stockton., CA 95205 <br /> ENVw <br /> IRONNIIENI HEALTH (209)468-3420 Fax: (209)464-0138 Web:ww.co.san joaquin.ca.uslehd <br /> PERiJ ITiSERVICES��_� Q kUSLIC RECORDS RELEASE APPLICATION <br /> APPWCANT- .+�_�"t 9144 _ 6USIN1ESS(AGENCY: , S C[�rl Vifirl/N/ 'y� '��^7 <br /> Ja •f7 / rl � L ��..-. /nhtPi6l�y1 I��V/ E }(dl L <br /> ADDRESS: r,M i C P I <br /> woNr;�2?i�—ro7L—7_02 t Acsmkatt: ��a710 — ---- <br /> TENTATIVV APPOINTMENT DATE: Tuna; <br /> (Please allow l0 bUsinaw days Inns dale of application submittal] <br /> ❑ CHECK DOX TO EXPEDITE REQUEST-S93A0 FEE—REQUEST PROCEwED IN 3 BUSINESS DAYS <br /> DATE __ <br /> SIGNATURE OF APPLICANT D-DarncM LISe Only <br /> UNIT <br /> FILE ADDRESS ❑ <br /> D Seg kr n� � Lnft 1 <br /> ,. so-cei ll/ I_ <br /> VIEW <br /> o L] Unit 2 <br /> a 9trea, <br /> nit 3 <br /> fi. <br /> Cr <br /> e. sx c Unit 4 <br /> s o L7 Unit5 <br /> 6. SY - <br /> C <br /> lo. EUx, <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> G HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)(yEAttUP SIT£(LOP) ❑ FOOD FACILITY <br /> El <br /> WASTE VEHICLE <br /> ❑ OTHER CLEANUP SITE(N(jN'LOP) ❑ DOG KENNEL G DAIRY <br /> r: UNDERGROUND TANK(MONRORINCIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATYJSXT PLANT <br /> G HAZARDOUS WASTE ISENER4TDR M MOTELJ40TEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> (Cl TIERED PERMnTED FACILITY ❑ PooLISPA 6 LAND USE APPLICATION SIMS <br /> ❑ TATTOOMODY PIFRCtNG ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the sele(t)of files from the list 138 Q by iI t0 tb^9 <br /> the appropriate box(es). At feast one file typo MUST be selected' Fez tO 209 Ati4-0138 or mai{to the <br /> address Indicated bove. mtment for review wilt be confirmed <br /> z. EHD wilt notify the applicant if any EHD fibs exist An aPtcation. The <br /> approximately five business days but no Tater the^ten{10) days afteeDei�hou dpba scheduled <br /> vri(I be held for a maximum of five business days for review. Alpo available for review. Anew <br /> accordingly. <br /> 3. A file that is actively belnB worked on by EHD staff may not be immediately <br /> application may be suse <br /> bmitted when the file is available. at the <br /> 4, Arty file not�n a�ture filein thesrevievvsnby the sa eI appllicantl may requare a$93.00 dD posit prior to eview, <br /> of the appwith HHD staff. <br /> 5, tTENTATIVE appointment dates must be confirmed Ced the HO business day. <br /> g - Applicatlons received after 3:00 pm <br /> TIME <br /> CONFIRMED APPOINTMENT DATE --- FAX INITIALS <br /> DATE CONFIRMEDPHONE <br /> YES NO REVIEVy DATE <br /> REVIEWED <br /> r.0 aa-0't <br /> Mm , <br />