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U1/Zl/Z17b4 16:0y yoli-b/yob MUULSIU AIU ,,.t'AUt _bl_ <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> U t STOCKTON CA 35202 ' <br /> JUL 2 1 2004468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAMvl E VJW/^FU`•1 BUSINIISSIAGENCY <br /> ADDRESS Po1un H,�vtvd 5,j-k <br /> PHONE Z ( - 'f,7,�.1 FAC IMILE <br /> IL <br /> TENTATIVE'APPOINTMCNT DATE z • TIME ��V4 <br /> (Plca.c pivC 7(a 10 hu.inas.days from data of a li <br /> PP Calion�Wmillaq <br /> © CHECK BOX TOAXP16TE REQUEST-$47.09 FEE <br /> JRCQVESTPROCCSSEDIN7BUSINESS DAYS yI <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF Us[ONLY <br /> a PROGRAM ELEMENTS SEARCH <br /> W. St n.lc t _ avC0. <br /> �S �Ct 1i Ave cl v\ • � S a!o I .\.L <br /> ?tel E. �Id1tvN11t NLau Ca, <br /> f 743 C �L W Co S Lk �y 3 /Y1 L <br /> 2 °tl >V >(1K SHOCK � r'o U rr. <br /> `14 KoTl v 9E Ls rya faro d <br /> i le MA F lvd Arc c /,l o <br /> Z hZ �Ll LL K <br /> tom( t 4bvo a 5}o�K V <br /> L� ENVIRONMENTAL HEALTH DIVISION FILES <br /> ! UNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZAROOUs wAsTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMIT74D FACILITY ❑ MOTEUHOTEL D PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PHIRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTL FACILITY ❑ PUBLIC WATER SYSXEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses in the space above. Select the typD(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 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 relcasad will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the Same applicant may require a $87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment datos 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 /> kM 99 14 a ?M <br />