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\ .r-18-04 11 : 27A P. <br /> q �- EIV "' FHD I QG NUMB <br /> �1 °I= �j/I5_ SAN JOAQUIN (,;AUNTY <br /> LTJ ENVIRONMENTAL 11EALTH DEPARTMENT <br /> MAR 1 8 2 Ad 304 R Wcher Ave 3id Floor Stockton, CA 95205 1 7 <br /> Q_(T9) <br /> 469-1420 Fax: (209)1164-0139 Web: www.co.san-,joaquin.ca.us/clic 3 <br /> I J <br /> ENVIRumNIti T HEALTH <br /> PERKT/ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: T (0'r BUSINESSIAGENCY/: / K,ca e A <br /> ADDRESS: C.� I S 44w C�S��7J� y� /1:�'Vl,_ L_.�oYpT�L�,/A . ����('(,oL �+�. .._- <br /> PHONE: .S�t ' 3� O - 3lT-GO.._.....__.FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: t I '�+ �" F� (9(V 1 Time: .41A W <br /> AW <br /> N. <br /> r QAR <br /> (Please allow 10 bus ' Gays from date f apPllcanon submittal) _ <br /> i <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 qU 5%PR S$ED IN 3 BUSINESS DAYS ( `� <br /> SIGNATURE OF APPLICANT DATE '_ $G I v <br /> UDDarbnaril Use Only <br /> /I FILE ADDRESS C U UNIT <br /> 1. 5vem "/. OKM Cnr 3 El Unit 1 <br /> s. Dyeet 5 r ,. T w w __-- . _._.-.� ❑ Unit 2 <br /> \Ir.a Cn d .r <br /> l4 Sveel D U V/1r{CGY/f/'1///yr///f) <br /> 7 s0,-1 MY - Unit 4 <br /> MAR M1 M1IMPI fil /rr1 G <br /> _ <br /> !1 MroPI fid V .. ` <br /> ❑ Unit 5 <br /> ID. sl,om <br /> ,J,/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> U ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACI Y , <br /> ❑ THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> lW(SERGROUND TANK(MON ITORIN GIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> p/HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑ MOTEUHOTEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOO/BODY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 now <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"42L -. ---.—...__ <br /> usrz000 <br />