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JUN-1'(-2Mb 16:19 CANDOR EARTH TECH 209 532 0773 P.02 <br />OANJVAVUuv x <br />ENVIRONWNTAL HEALTH DEPARTMENT <br />304E Weber Ave 3 Floor Stockton, CA 95205 1 g <br />w u;v Q U 201P99) 468-3420 Fax: (209) 4640138 Web: wWW.00,san-joaquin.ca.us/ehd <br />CNVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: FAT.(j 6,5U7.a _c 7_ BUSINESS/AGENCY: LJW R — J�jH �CU.(� JA,r <br />ADDRESS: 0�.160(03 belgN IANC- <br />• <br />PHONE: 2-09 + S3a.0361 FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: 00 Time:. 1 <br />(Please allow 10 buslness days from da a of epplloatlon submlttal) <br />❑ CHECK BOXTO EXPEDITE REQUEST -$93.00 FEE- REQUEST PROCESSED (2 1111 11 11 U 111INnn3FFBUSINESS DAYYS�� <br />SIGNATURE OF APPLICANT E AMIE <br />lJ <br />,-,%T- <br />T <br />FILE ADDRESS <br />- <br />so -fill <br />a <br />2. <br />su" <br />3 <br />G <br />3. <br />sve <br />l0 <br />a <br />1. <br />s.sem <br />= <br />u s Fi wl ve • <br />c <br />6. <br />9vae1 <br />w <br />9T 61 <br />City <br />7. <br />SEeel <br />(,S-1 <br />City <br />X710 <br />a- <br />9. <br />6V <br />15� . <br />^ W . <br />10. <br />Sv <br />d% Q 5.ock-fonVL <br />C"y <br />Department Use Only <br />UNIT VVVV <br />[] Unit 1 <br />Unit 2 <br />/Unit 3 <br />�Unit4 <br />❑ Unit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES P <br />W"e y W <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT_p, SOLID WASTE FACILITY 04 <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY YS SOLJO WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINOIREMOVAL) ❑ DOG KENNEL 92!r DAIRY <br />HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />13 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YAHUICHFM TOILETS <br />0 TATTOOMODY PIERCING ❑ POOLISPA FL -LAND USE APPLICATION SITES <br />Ire' MEDICAL WASTE FACILITY P OTHER (PLEASE SPECIFY) <br />1. List up to ton addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate boX(es). At least one file type MUST be selected. Fax to (2091464.0138 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 released will be reorganized by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review <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 day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED _ YES NO <br />TIME <br />PHONE FAX <br />RE1/IEW DATE <br />INITIALS <br />TOTAL P.02 <br />