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EHD LOG NUMBER DATE RECEIVED SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ZN4 304 E Weber Ave 3`d Floor Stockton,CA 95205 OCY 1 1 (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd i=s PUBLIC RECORDS RELEASE APPLICATION APPLICANT: Pop r V-C,C c 0 BUSINESS/AGENCY: ADDRESS:-902- PHONE: DDRESS: 90ZPHONE: 3tpq -3--m1 FACSIMILE: TENTATIVE'APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT �� - DATE I I I y Department Use Only FILE ADDRESS 1 _ UNIT VC t. Street D-4 N / , S-t . �P a l�"�� . 2. Street 3�}oi-+ S- (a\r avk W S't-a cktbh• -( �' - gyp E] Unit 1 3. sneer Z10S1 S. a Shoelmtti1 �7 z 22L ,Fxxl ❑ Unit 4. sneer x7113 C. M 06 n S A, oy SA--be 3 S. street 515 7 E• YO--V_, 'SA a S�•'tL+_r E- ^- u4 Unit %f 6. S3�"'-I'� �, �✓`"�1S.L aty treet J'i ✓C.I�'�� r. street 3 82 C- L-ucV� R re city Stm cl�tr�% Unit 6. So-eel 3 `16th Cjv-C.t �� S-e" a SfiuC IeI-Un ZZ 9 Street t'1-131 S e . YIA GtF h S'I a S"I"D L k_4-m^" ❑ Unit 5 10 street -51 9 N. -F. V4-7n- fl"ve . Calty Sib t,le_ C)C�aENVIRONMENTAL HEALTH DEPARTMENT FILES 1 ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY E3SOUD WASTE VEHICLE OTHER CLEANUP SITE(NON-LOP) UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY ❑ MOTEIIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10)days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to re 'e 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT:PATE TIME DATECONFIRMED 'PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EHD4842406 6/62003