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DATE RECEIVED SAN JOAQUIN COUNTY EHL)LOU;'W,11L)Llti <br /> ENV+.,ONMENTAL HEALTH DEPART,_ENT <br /> Al <br /> -11B04 E Weber Ave 3d Floor Stockton, CA 95205 <br /> - <br /> 17_-1 (209}4 6�l-C3420 Fax: (209)464-0138 Web: www.co.san-joaquin.caus/ehd <br /> 31 <br /> 03 AUG 13 AM 1LC RECORDS RELEASE APPLICATION <br /> APPLICANT1 - <br /> Z(I BUSINESS/AGENCY: <br /> :,h.4/V )c <br /> ADDRESS: <br /> PHONE: FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: ';L6oz Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—RE EST PR9CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1- Street ,It- zo�� ,:?6",74 city F1 Unit 1 <br /> 2, Street 7 j 3 e'�q city <br /> 3. street 7L",) Cit zzr_ <br /> F] Unit 2 <br /> 4. Street 471.-L;CI a�Z <br /> Cit 5. Street r Ca <br /> U <br /> City nit 3 <br /> S. Street <br /> 7, street .?50 City Cit <br /> (KUnit 4 <br /> 9. Street City nitt 5 5 <br /> 14. Street Ci t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> � UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 13 OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL El DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR El CHICKEN RANCH 11 PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL El PUMPER TRUCK/YARD/CHEM TOILETS <br /> 1:1 LAND USE APPLICATION SITES <br /> 13 TATTOO/BODY PIERCING 13 POOLJSPA <br /> 0 MEDICAL WASTE FACILITY ED 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 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 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 43.02-006 <br /> 8/812003 <br />