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CATE RECEIVED - =HD LOG NUMSFP, <br /> SAIN JOAQUIN COUNTY`-" <br /> E.NVIROMIENTAL HBI A.LTFI DEPAiiTm,NT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 n <br /> (209) 464-3420 Fax: (209) 464-0138 Web: www.CO.san-joayuin.ca.us/chd L <br /> _ / FPUBLIC RECORDS RELEASE APPLIlCATION <br /> APPLICANT:/j' /loI ] 61hew•Iy _BUSINESSIAGENCY:, A) ArQfVCS"', <br /> ADDRESS: A02 ZYllll'I�J'�'Yl n L 17A <br /> PHONE:bFACSIMILE:AAAA <br /> TENTATIVE"APPOINTMENT DATE:_ Yf`*_t-Ck, 2�r 7-00�-- <br /> (Plaase allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$933..00 FEE-�R+E(QUEST PROCESSBb IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1 Ft EZ 4 F� E^r ..21 DATE <br /> pep3rtmanl IJ$P.Only <br /> FILL:ADDRESS UNIT <br /> I� <br /> Itrrl !T eKM4Lh1 �;A uw LAS ' <br /> Unit 1 <br /> z. sled � Py _ <br /> ❑ <br /> S. Sinal CII <br /> ❑ Unit 2 <br /> n. so-eel Cer <br /> a. SVEN pw Unit 3 <br /> 6. 51mel Cllr (/\ <br /> 7. seel Cllr Unit •e <br /> Sveel CnvUnit 6 <br /> J <br /> A p rr-I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IP/UNDERGROUNO TANK(USTI CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> LGA OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> SiMAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> CW TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> • ❑ TATTOO/BODY PIERCING ❑ POOLISPA 17 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. END 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. Afile that Is actively being worked an by EHD staff may not be immediately available for review. Anew <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 hythe 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 4947.499 <br /> &98003 <br />