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( uai uui �uu r <br />EKO LOG HUM85R <br />�,' I� SAN JOAQUIN COUNTY �} <br />x ENVIRONMENTAL HEALTH DEPARTNI�;NT <br />Sok JUN 0111) 304 El Weber Ave P Floor Stockton, CA 95205 <br />�(2 9) 468-3420 Fax: (209) 464-0138 Web: www.co.sanjonqum. . 2-h <br />NVIIRJNMENT HEALTH <br />PEMMi T/SE,,q PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Claudia Gemberling SUSiNESSIAGENCY: San Joaquin County public Works Department <br />:I <br />p,DDgS;1810 E. Hazelton Avenue, Stockton, California 95205 <br />PHONE: 953-7624 FACSIMILE: 468-2999 <br />TENTATIVE" APPOINTMENT DATE: Timo: <br />,f <br />(Please allow 10 business days from date of application submittal) <br />J� <br />CHECK 13OXTO EXPEDITE REQUEE:9T-- $93,00 FEE - REQUEST PROCESSED IN 3 BUSW£SS DAYS <br />SIGNATURE OF APPLICANT (its-u.�L Q. DATE <br />Department Use Only <br />1Y U 1 ,3b FAI Z0400H SH PUMU �V�Klt � `�v�" <br />ate. <br />UHrr <br />❑ Unit 1 - <br />❑ Unit 2 <br />it 3 <br />e, Un <br />Unit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />i <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING Ai3ATERENT 0 SOLID WASTE FACILITY <br />OTHER CLI ANUP $rrE (NON4-OP) 0 FOOD FACILITY '' 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGR"OVAL) 10 DOG KENNEL O ' DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CFIICKEN RANCH i; ❑ PKG TREATMENT PLANE <br />TIERED PERMITTED FACILITY E3 MOTELIHOTEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br />t7 TATTOOIBODYPIERCING 17 POOLISPA 3p C3 LAND USEAPPAICATION SITES <br />E3 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />1. Last 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 selected2i Fax to 209 464-0138 or mai(to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appolntm qt 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 y <br />accordingly. I <br />3. A file that is actively being worked an by EHD staff may not be immediately available for review. A new <br />application may be submitted when the file is available. 1i <br />4. Any file not returned In the same condition as released will bereorganlzod by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant Mayer"quire 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 buslness day. <br />!1 <br />F1{uEinw�.. �..—.�..._�....LL <br />DA���I+rFIi2ME'.i3 . � <br />EM U424H <br />!� <br />.I <br />M2003 <br />FILE ADDRESS <br />z <br />3bW L4 Cit ip <br />3 <br />shit'PhyI� <br />4. <br />5VWO CI <br />r <br />5. <br />Shod " <br />7- <br />shecl r Cky <br />S. <br />SbImA f city.. <br />9. <br />shoat <br />70. <br />Shwa, -7q-71 15, <br />UHrr <br />❑ Unit 1 - <br />❑ Unit 2 <br />it 3 <br />e, Un <br />Unit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />i <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING Ai3ATERENT 0 SOLID WASTE FACILITY <br />OTHER CLI ANUP $rrE (NON4-OP) 0 FOOD FACILITY '' 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGR"OVAL) 10 DOG KENNEL O ' DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CFIICKEN RANCH i; ❑ PKG TREATMENT PLANE <br />TIERED PERMITTED FACILITY E3 MOTELIHOTEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br />t7 TATTOOIBODYPIERCING 17 POOLISPA 3p C3 LAND USEAPPAICATION SITES <br />E3 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />1. Last 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 selected2i Fax to 209 464-0138 or mai(to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appolntm qt 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 y <br />accordingly. I <br />3. A file that is actively being worked an by EHD staff may not be immediately available for review. A new <br />application may be submitted when the file is available. 1i <br />4. Any file not returned In the same condition as released will bereorganlzod by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant Mayer"quire 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 buslness day. <br />!1 <br />F1{uEinw�.. �..—.�..._�....LL <br />DA���I+rFIi2ME'.i3 . � <br />EM U424H <br />!� <br />.I <br />M2003 <br />