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UU/Ub/ZUU( WEV 10;Jb PAA ZUHUNH SK PUBLIC H'UHKS. 4002/002 EHO LOG NUMOER SAN JOAQUIN COUNTY L, 7� �k ENVIRONMENTAL HEALTH DEPARTMENT hd NT .I `1 FN 5 �0 q v 720U7 304 E Weber Ave 3'd Floor Stockton, CA 95205 a ,II�R (2b9) 468-3420 Fax: (209) 464-0138 Web: www.cosan joaquiR.cau 1 v.�,�IdVT NtALTH VVV ti\ �Ehivfli/�_RV;�, PUBLIC RECORDS RELEASE APPLICATION APPLICANT: Claudia Cemberling BUSINESS/AGENCY: San Joaquin County Public Works Department ADDRESS: 1810 E. Hazelton Avenue, Stockton, California 95205 PHONE: 953-7624 TENTATIVE' APPOINTMENT DATE: FACSIMILE: 468-2999 TIma: (Please allow 10 business days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST -$93.00AFEE —REQUEST PROCESSED IN 3 BUSINESS DAY: SIGNATURE OF APPLICANT LAG 21L!%11if ! CE R (fu\ V, W� DATE IP - � -e 'I Department Use Only UNIT cr,5 - \V ❑ Unit 7 ❑ Unit 2 era Unit 4 /�ffff_fflI '. riiL� a ■(! J '��:. �ii1 • f 1 �>.l:i Ila.'• 1(!AI J ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ -SOLID WASTE VEHICLE UNDERGROUND TANK(MONMORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY rn MOTELIHOTEL O PUMPER TRUCKIYARD/CHEM TOILETS TATTOOBODY PIERCING C3 POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY O 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 typo MUST be selected. Pax 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 review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. �CONFIi 11![EI5 Lx40T E(T 1b3 SINK -, �JfIIA1-S IteuEuyF© Y> S NQ t_#1FIE1NTid7.E exo.ename , Waaw Department Use Only UNIT cr,5 - \V ❑ Unit 7 ❑ Unit 2 Unit 3 Unit 4 E5 ❑ Unit 5 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ -SOLID WASTE VEHICLE UNDERGROUND TANK(MONMORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY rn MOTELIHOTEL O PUMPER TRUCKIYARD/CHEM TOILETS TATTOOBODY PIERCING C3 POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY O 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 typo MUST be selected. Pax 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 review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. �CONFIi 11![EI5 Lx40T E(T 1b3 SINK -, �JfIIA1-S IteuEuyF© Y> S NQ t_#1FIE1NTid7.E exo.ename , Waaw