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DATE RECEIVED <br />- - iD) i <br />APPLICANT: <br />ADDRESS: 116 (orr.g\-0 <br />PHONE: (75) -()CCO _Ett_ FACSIMILE: 2-- P( <br />DEC 3 1„ gin <br />H40 mEN -1- ;-4,EN <br />TENTATIVE* APPOINTMENT DATE: 5111 t Time: t 0610r\ <br />(Please allow 10 business days from date of application submittal) <br />El CHECK BOX TO EXPEDITE REQUEST -$93.00 F E - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SA.N JOAQUTN COUNTY <br />ENVIRONIVIENTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3'1' Floor Stockton, CA 95205 <br />468-3420 Fax (209) 464-0138 Web: wivw.co.san-joaqui.n_ca.usiehd <br />, PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGEN,CY: <br />DATE --\ <br />SIGNATURE OF APPLICANT <br />FILE ADDRESS <br /> <br />1. See a. /?-10/3 A . W 11 so,r, kiv 2 <br /> <br />s. 14 1 ti-c. <br />Mk- <br />N W ,. Wn.. <br />Svce. A V1 <br />7 &feet 'ti tl <br />8 Sired 2-1 <br />.tee, 1-16(0 N ,_11ilsc <br />10. Street 1.A/ <br />" H.V.7 9/e_O <br />CRY-- <br />Cry <br />Department Use Only <br />12/28/2003 18:38 9252r --121 AEI CONSULTANTc (SF) PAGE 01 <br />EHO LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />0 HOUSING ABATEMENT <br />CI FOOD FACILITY <br />LI DOG KENNEL <br />CI CHICKEN RANCH <br />MOTEUHOTEL <br />LI POOL/SPA <br />LI OTHER (PLEASE SPECIrY) <br />1ik SOLID WASTE FACILITY <br />El SOLID WASTE VEHICLE <br />In DAIRY <br />PKG TREATMENT PLANT <br />0 PUMPER TRUCKJYARD/OHEM TOILETS <br />X LAND USE APPLICATION SITES <br /> <br />MEDICAL <br />List up to ten addresses in the space above. Select the type(s) of files from the list above by checkin,c <br />the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to <br />the <br />EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed address indicated above. <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 <br />of five business days for review. Appointments should be scheduled <br />A file that is actively being worked on by EHD staff may not be immediately available for review. A ne accordingly. <br />application may be submitted when the file is available. <br />Any file not returned in the same condition as released will be reorganized by EHD staff at the expens <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revie <br />"TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />CQNFIRTMED.APpOINTMENT DATE ,.._;..,. <br />.r- • <br />. TIME . <br />DATE CONFIRMED . "PHONE -:' FAX 'van. <br />REVIEWED YES NO REVIEW DATE <br />' END 48-02-1706 <br />arat2903 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />tEt OTHER CLEANUP SITE (NON-LOP) <br />Pt. UNDERGROUND TANK (MONITORING/REM(VAL) <br />7, HAZARDOUS WASTE GENERATOR <br />JA <br />TIERED PERMITTED FACILITY - <br />TATTOO/BODY PIERCING <br />0 WASTE FACILITY