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a EHD LOG NUMBER DATE RECEIVED �, • SAN JOAQUIN COUNTY c r, Di I— ENVIRONMENTAL HEALTH DEPARTMENT � 1 1 2�4 304 E Weber Ave 3`d Floor Stockton, CA 95205 � q GC (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd Ft d, rIL rS PUBLIC RECORDS RELEASE APPLICATION APPLICANT: A6L� V=ckC C a BUSINESSIAGENCY: rykL D ADDRESS: PHONE: �j� -�� FACSIMILE: '-72b rl- Z+ 72-'R" TENTATIVE' APPOINTMENT DATE: Time: G (Please allow 10 business days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST - $93.00 FEEgg— REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE�Oy w Department Use Only FILE ADDRESS UNIT I C \ �V" haft' vv Q`�� _ i ��S ENVIRONMENTAL HEALTH DEPARTMENT FILES �C� n`a13SOLID WASTE FACILITY UNDERGROUND TANK (UST) CLEANUP SITE (LOP) [3❑SOLID WASTE VEHICLE HOUSING ABATEMENT OTHER CLEANUP SITE (NON -LOP) E3FOOD FACILITY UNDERGROUND TANK (MONITORINGIREMOVAL) ❑DOG KENNEL 13 DAIRY Cl CHICKEN RANCH E3PKG TREATMENT PLANT HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS TIERED PERMITTED FACILITY ❑ POO�PA ❑ LAND USE APPLICATION SITES TATTOO/BODY PIERCING E3 OTHER (PLEASE SPECIFY) 13 MEDICAL WASTE FACILITY 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 IK of the applicant. Future file reviews by the same applicant may require a $93.00 deposit priore 5. `TENTATIVE appointment dates must be confirmed with EHD staff. ry, 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED 'PHONE . FAX INITIALS' REVIEWED _ YES NO REVIEW DATE V°CX` -V E] Unit 1 nn C'-�3 4)L Z V co � SSI S. P''. ;'e A- W a Skock�� / z ❑ Unit MVC, n S: A, Ci -4TU CIctri E, Mw -'N S-�• 0'y r Unl �j�'"✓-� G. NSG. ' alyS'1 •'L lc.'�"�l� at, Gt-- 9n774 �J� �• I.SV-(tet VA S, G- tv--t c, St-ucle-t� ZZ /( iSl� Ei IMG V S1. ✓ a S+VC,I Unit \ �V" haft' vv Q`�� _ i ��S ENVIRONMENTAL HEALTH DEPARTMENT FILES �C� n`a13SOLID WASTE FACILITY UNDERGROUND TANK (UST) CLEANUP SITE (LOP) [3❑SOLID WASTE VEHICLE HOUSING ABATEMENT OTHER CLEANUP SITE (NON -LOP) E3FOOD FACILITY UNDERGROUND TANK (MONITORINGIREMOVAL) ❑DOG KENNEL 13 DAIRY Cl CHICKEN RANCH E3PKG TREATMENT PLANT HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS TIERED PERMITTED FACILITY ❑ POO�PA ❑ LAND USE APPLICATION SITES TATTOO/BODY PIERCING E3 OTHER (PLEASE SPECIFY) 13 MEDICAL WASTE FACILITY 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 IK of the applicant. Future file reviews by the same applicant may require a $93.00 deposit priore 5. `TENTATIVE appointment dates must be confirmed with EHD staff. ry, 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED 'PHONE . FAX INITIALS' REVIEWED _ YES NO REVIEW DATE