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DATE RECEIVE Q <br />SAN JOAQUIN COUNT <br />ENVIRONMENTAL HEALTH DF <br />ZOO, 304 E Weber Ave 3`d Floor Stockton', <br />��� 1 (209).468-3420 Falx: (209) 464-0138 Web: www.CO.s <br />PUBLIC RECORDS RELEASE A] <br />APPLICANT: - V-C&r- c 0 BUSINESSIAGENCY: 1� AAADDRESS: �dZ 1v�S� lA7r�.1 Lo[� i <br />PHONE:! -3� FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: <br />END LOG'NUMSER <br />'ARTMENT <br />CA 95205 <br />to joaquin.camslehd <br />.TION <br />k, <br />Time: <br />11 <br />(Please allow 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE. REQUEST - $93.00 FEE— REQUEST PROCESSED IN 3�BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 1 a <br />Department Use Only <br />1 <br />❑ Unit 1 <br />FILE ADDRESS <br />1 <br />1. <br />Street L 0-4 N, S c xA"� S-A <br />Ci <br />a` <br />5A <br />aty <br />S,, Glc }6?^• Z I? <br />54. <br />Pill <br />a <br />S +-b <br />4. <br />Street rJ 1 `V '1j G . M tx:t n S -i . <br />Cj1y <br />S. <br />Street `r71 �i7j I ., M --. V, s� !. <br />at, <br />S. <br />Street ?V -714c) <br />C C—V<--V," 9 L. <br />'&V -e ` A)FGty <br />trl� Ali,i, <br />r. <br />Street 39-92- <br />E. G-Uc-1 ►n <br />RV -t- Al f <br />S c 'i ceAK <br />a. <br />street 3 Y� <br />� � &U -C,% +,A L <br />ft —t i) r a <br />91`z Street +131 S <br />m � +� S-A .� <br />F Ci <br />5 �D -"b <br />10. <br />Street 51 1 <br />A.I. ` - ' ' "V P ` + G <br />�G-IICL� <br />sob-Cir., <br />0.9:Ife-. ') h.Wll_ c` fL vtJ� 1 <br />ENVIRONMENTAL HEALTH DEPAR <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 13 HOUSING ABATEMENT <br />OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY <br />UNDERGROUND TANK (MONITORiNGIREMOVAL) 0 DOG KENNEL <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH <br />TIERED PERMITTED FACILITY 0 MOTELIHOTEL <br />TATTOOIBODY PIERCING 13 POOLISPA <br />0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECT <br />9. List up to ten addresses In the space above. Select the typ( <br />the appropriate box(es). At least one file type MUST be sele <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appo <br />approximately five business days but no later than ten (90) + <br />will be held for a maximum of five'business days for review <br />accordingly. <br />3. A file that Is actively being worked on by EHD staff may not <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will <br />of the applicant. Future file reviews by the same applicant I <br />5. *TENTATIVE appointment dates must be confirmed with EH <br />6. Applications received after 3:00 pm will be processed the n <br />ENT FILES <br />© SOLID WASTE FACILITY <br />0 SOLID WASTE VEHICLE <br />13 DAIRY <br />0 PKG TREATMENT PLANT <br />PUMPER TRUCKIYARDICHEM TOILETS, <br />0 LAND USE APPLICATION SITES <br />s) of files from the list above by checking <br />led. Fax to (209) 464-0938 or mail to the <br />itment for review will be confirmed <br />iys after receipt of application. The files <br />Appointments should be scheduled <br />Immediately aVallble for review. A new <br />reorganized by EHD staff at the expense <br />ty require a $93.00 deposit prior to reWelff <br />staff, <br />t business day. <br />0 <br />CO N'F1kMtb-A00-(jlNiME`NT DATE.r TIME _ T: <br />DATE CONFIRMED `:PHONE FAX'" " INITIALS <br />REVIEWED YES NO REVIEWIDATE <br />❑ Unit 1 <br />� CO <br />_ , y <br />❑ Unit 2 <br />Unit 3 <br />Pill <br />Unit 4 <br />nit 5 <br />ENT FILES <br />© SOLID WASTE FACILITY <br />0 SOLID WASTE VEHICLE <br />13 DAIRY <br />0 PKG TREATMENT PLANT <br />PUMPER TRUCKIYARDICHEM TOILETS, <br />0 LAND USE APPLICATION SITES <br />s) of files from the list above by checking <br />led. Fax to (209) 464-0938 or mail to the <br />itment for review will be confirmed <br />iys after receipt of application. The files <br />Appointments should be scheduled <br />Immediately aVallble for review. A new <br />reorganized by EHD staff at the expense <br />ty require a $93.00 deposit prior to reWelff <br />staff, <br />t business day. <br />0 <br />CO N'F1kMtb-A00-(jlNiME`NT DATE.r TIME _ T: <br />DATE CONFIRMED `:PHONE FAX'" " INITIALS <br />REVIEWED YES NO REVIEWIDATE <br />