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SAN JOAQWN COUNTY - - - <br /> r f 1V D L(10,�IRONMENTAL HEALTH DEPAAvAENT <br /> MARJ .5 2004 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0139 Web:www.co.san-joaquin.ca.uslehd. 1.30 <br /> ENVfP;;NMENT HEALTH <br /> PESMITJSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (Z BUSINESSIAGENCY: <br /> () <br /> ADDRESS: � f� C_ C7 J/L4+1)Q S-T— . S T`O C, !C —1)N � <br /> � �• <br /> PHONE: 9 7 FACSIMILE: -7 y V 4 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please alloy 10 business days from date of application subm!Ual) <br /> ❑ CHECK BOK TO EXPEDITE REQUEST-$93.00 F E RE T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE S. �5 <br /> Department Use 0* <br /> FILE ADDRESS UNIT {� <br /> S-- 4iz_ oty s r o c V_-r� �J ❑ Unit'S C�-1 <br /> �. a <br /> �. ❑ unit 2 <br /> 4. Street <br /> s. s� a �Uni <br /> s. AJ-4 CAY <br /> r. Street Unit <br /> s. Sweet <br /> e. saed ❑ Unit 5 <br /> 10. saeet city <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> Xi UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SoLio WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ODHAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> -WTIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCIVYARDICHEM TOILETS <br /> ❑ TATrOCMODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL.WASTE FAICII rrY 0 OTHER(PLEASE SPECIFY) <br /> f, 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 209 454-0138 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. Anew <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 AP�biNTM 14fbA T1ME <br /> :SATE CONFIRMED _ kWE - FAX- . .; <br /> YES 'NO REVIEW DATEkKD 0-6:55t <br /> _ <br /> WV2H3 <br />