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bLt -2y-2004 1b;28 y1' 1�1 1977 915 9i'1 19`77 `, F.01/Ui <br /> U.y1C RCLCIVCU - -' <br /> SAN J•OAQM COUNTY <br /> _ - ENVIRONMENTAL HEALTH DEPARTMENT 90q5 S E.P 2 9 200 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> �Z09)468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIR_ HL;'I I-H <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i J or 7b se BUSINESS/AGENCY: , <br /> ADDRESS: 8321 Po..se� �v,r� ✓Toa.a C, �360/f C�o.�+e1.�e��`d G l4 e}Sa Z (n <br /> PHONE: q ICa- q%T - `a`(s`{ FACSIMILE: <br /> r (0 rZ•D`t O <br /> TENTATIVE APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS // <br /> /Jt7 n� <br /> VC_>4 01r:)7eJ3 FG �ltc; ❑ Unit 1 <br /> 1 _r �T. G T && `4 <br /> Z 5t<eet <br /> G 4UT. �5�y ?' = `1�C�✓ ❑ Unit2 �C_-7-0 <br /> 3. Street <br /> / 4. stnwt Jct 1 t1►�d C 1 � <br /> s. sll�e 1icity Unit 3 <br /> 6. street C <br /> 7. S,— Unit 4 <br /> e. Sweet <br /> � 9. Street <br /> c �" ❑ Unit 5 C- <br /> 10. Street C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES X U1� <br /> W.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT fa SOLID WASTE FACILITY <br /> )S OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITOR]NGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> N HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTFUHOTEL ❑ PUMPER TRUCKrYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOMPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten 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(209)464-0138 or mall 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 END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. Eyp {{at the expense <br /> 4. Any file not returned in the same condition as released will be reorganized by P <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 /> -- <br /> :. .._.. <br /> =4POWUP <br /> NO :. ATE� REVIEW IEMD <br /> exnas-oz-0o6 t ` ��Ft U.37 4'rt ��1�r,� d n'S5, a�2�)5elk'Ic' Ud. : SS...�{5 jS <br /> RAM= 7J e7 'I ' S <br /> TOTAL P.01 <br />