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DATERECEIVED iI LFiu LUv WU,vwt„V <br /> SAN JOAQUIN COUNTY <br /> EN LONMENTAL HEALTH DEkRT NT <br /> u+"i�Jlr_ l'I A�. rit��_1 IB04 E Weber Ave 3rd Floor Stockton,'i, 95205 <br /> r' T;(-fG9)l4�6$a3420 Fax: (209) 464-013$ Web: wwwJL4 31 <br /> .co.san-joaquin.camslehd <br /> 03 AUG 13 AM %ALIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r BUSINESSIAGENCY: <br /> ADDRESS: V cu 00 <br /> PHONE: FACSIMILE: } <br /> a <br /> TENTATIVE'APPOINTMENT DATE: j Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST 93.00 FEE—RE UEST PR CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 7 t 0G G DATE <br /> Department Use Only <br /> FILE ADDRESS 7�( .j UNIT <br /> ❑ Unit 1 <br /> 2. S,reet Cil �n c-yG <br /> 3. Streel —0 r■ - c S f x la 3h Cil <br /> 4. Street i- 'c,.:.t Cir¢ .ra 3C�� Cit / _ 333 El !.)nit 2 <br /> A Cit5. Street <br /> _- I nit 3 <br /> 6. Street & r� City <br /> T. Street ,250 Cit <br /> 0. Street Cil Unit 4 <br /> Wit <br /> Street Cit t5 <br /> •�_ <br /> 10. Street Cit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> DOG KENNEL <br /> UNDERGROUND TANK(MON ITORIN GIREM OVAL) Cl D <br /> DAIRY i <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ! El �PKG TREATMENT PLANT <br /> IJTIERED PERMITTED FACILITY ❑ MOTEL/HOTEL � PUMPER TRUCUYARD!CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING 0 POOLISPA ;� ❑ LAND USE APPLICATION SITES 4 <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)I <br /> 1. List up to ten addresses in the space above. Select the type(is) 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 0ir mail to the <br /> i <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. .I; <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 /> I <br /> CONFIRMED APPOINTMENT DATE TIMI~ <br /> DATE CONFIRMED PHONE FAX�-' INITIALS <br /> REVIEWED YES NO REVIEW DATE ' <br /> EHD 48-x2.006 { <br /> - 8l8f200S i - <br />