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Y SAN JOAQWN COUNTY <br /> \` I ENVIINMENTAL HEALTH DEPARThfi'�I <br /> 304 E Weber Ave 3 Floor Stockton,CA 95205 <br /> APR 2 3 ( , 468-3420 Fai: (209) 464-0138 Web:w,,vw.co.san-joaquin.mus/ehd <br /> - ALJ H PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT:_ e.1�5rY jt/js,F'ysUS1NESSIAGENCY: FL)6F-6 f,fJ <br /> ADDRESS: 2$$0 ,0- '7A,fC'Y &-pP, 5cw/7- ?. 79,4,4Y, -���' 17: 37< <br /> PHONE: Q d FACSIMILE:�09• '536- 6675 <br /> TENTATIVE*APPOINTMENT DATE: !4 54 P T C A�!�^' R <br /> (Please allow 10 business days from date of application su itt3 0�' <br /> ;E(�MCK BOX TO EXPEDCTE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. see ? uCity t,4d Unit 1 <br /> 2. Sa cti a 1r <br /> s. s+ a d h Unit 2 `t Z —0 i <br /> 12 3q <br /> s s--e 1 60410 city Lif 7/076)0 Unit 3 <br /> 6. Stme{ 7 6 19 G titd 4 <br /> r. str e *213 15 LA I c p <br /> e. v et cti \, Unit 4 <br /> s <br /> e X5 I .moi�� <br /> 9. "Wed Unit 5 <br /> io. sty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES` ? l "" <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ASATFJ+IEN7 tf SOLID WASTE FACILITY`" <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FAc Lrry n-SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 'DOG KENNEL rrDAIRY <br /> S WASTE GENERATOR CHICKEN RANCH 0- KG TREATMENT PLANT T" <br /> TI <br /> P>=RMrrTED FACILITY �`MOTELIHOTEL ,Z�UMPERTRUCKJYARDlGHE6A TOSLET <br /> TATTOOBOUY PIERCING 9.POOLISPA LAND USE APPLICATION SITES <br /> !+MEDICAL WASTE FACILITY PKOTHER(PLEASE SPEC1MY A V Y &L,--j E2)0- 5,17F=5 - <br /> 1. List up to ten addresses in the space above. Select the type(s)of tiles 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. EMU 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 new <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 END 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. "TENTAT[VE appointment dates must be confirmed with END staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> _..CONMWED'-APPOINT MENTDAT�.,:`-`. <br /> HATE CONFIRkt' PHONE FAX" tNlTIAi:S <br /> REVIEWED YES NO RtVIEW DATE <br /> EK0 48-02-0a6 <br /> QIEf200 S <br />