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05 2004 1 : OGPM r_-FOLOGICR 1 .5977880 P. 1 <br /> 03/05/2004 11:52 46:. E3 ENVIRONMENTAL HEALTH <br /> �� (`'�("�" ("��"/Jw � PAGE 02 <br /> SkNJOAQUINCOUNTY <br /> ENYiRONMF-NTAL HEA,LTI1 DEPARTMENT <br /> MAR 0 8 2004 304 E WCber Ave 3'd Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co,san joaquin.ca.ustchd <br /> 10RUNMENT HEALTH <br /> Irl? PUBLIC RECORDS]RELEASE APPLICATION <br /> APPLeCMT: I° <br /> 48USINESSIAGENCY:_ e� OC, ,� Y\G <br /> ADDRESS: <br /> PHONG: S FACSIMILE: `T CJ <br /> TENTATIVE,APPoW NENT DATE. D <br /> Time: i LcW� <br /> (PWaas lllow 10 buakw s days from date of appliacon cubmtft4 <br /> CHECK 13OXTO EXPEDITE 4rWrS 033 F — UE PR I: SID IN3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Departnwn Use Only <br /> FILE ADDRESS UNIT <br /> +• s..� 3 <br /> t se.w 2r is D Unit <br /> R5t U \1 <br /> I o << unit 2 p <br /> a, sse.t C t <br /> Unit 3 <br /> •. eaee+ Unit 4 <br /> a. aueec . <br /> ❑ Unit 5 <br /> 1 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ' t1NDERGROUND TANK JUS )CLEANUP SM(LOP) Q HOUSING MATEMENT <br /> ,�OTHER Cl EANUP alts SOL 10 WASTE FICtI r1Y <br /> iwow4wpi O FOOD FACKM a SO1L1n WASTE VEHICLE <br /> �Xt*"ROROUND TAKK(MONR'oRl1omFmOvAt.L) ❑ DOG KENNEL <br /> NAZARD�OUS WASTE GENERATOR Q CHICKEN RANCH 13 DAIRY <br /> PKI TREATMENT PLANT <br /> d TWRED PERMnn1D FACILITY ❑ MOTELMOTEL <br /> TATTOOIDODV PIERCING ❑ POOLISPA M PUMPEFt TRUCK/YARWCHEM TOILETS <br /> ❑ MEDICAL WASTE FACILITYO LAND USC APPLrCAT10N SITES <br /> ❑ OTHER(PlFJl9E t;PEGIFY) <br /> 1- Ust up to ten addresses In the space above. Select the typo(&)of fires from the list aboye by checicln0 <br /> the appropriate box(es), At least one file type MUST be selected. Fax to(209)464-0138 c mail to the <br /> address Indicate above <br /> 2- EMU will notify the appilcsnt If any EHO tiles exist. An Appointment for review wVI be Confirmed <br /> approximately Ave business drys but no later than ten(10)days after recelpt of application. The flies <br /> will be held for a maidmum of five buvJness days for review. Appointments should be sehedulcd <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 relumed In the same condition as released will be reorganized by EHD&Uff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$9300 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with ERD staff. <br /> 6. Applications received atter 3:00 pm will be processed the next business day. <br /> :�i •11dIPl�bINTM N DATE;;.:: '�''" '�t�►�. r—: <br /> TIME �.�+{ ''r� r.� >. r,:.• <br /> 'PHEFAX <br /> ... •'• ;�:�''` •- ;�:::',aNit'�a.ns =d:.�;•' <br /> 1ttEY1lalVEb h`. YES NO <br /> REVIEW DATE" <br /> 4d1-0K <br /> •' <br /> V <br />