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DMGFq,AlvI'�� <br /> I',_'I SAN JOAQUIN COUNTY 41EHD LOG NUMBER <br /> SEP 0 9 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> EfdPERti11'7 S R(209 ,468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.us/ehd 00.5 <br /> PUBLIC) RECORDS RELEASE APPLICATION <br /> APPLICANT: (A r BUSINESS/AGENCY: �C �-'-'� <br /> ADDRESS: -7 <br /> PHONE: (� 1 -5 2 ! Q l9 to FACSIMILE: `7 -ZO ( Q oL(' 5-(0� <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) LC� <br /> CHECK BOX TO EXPEDITE REQUEST•$9300 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 73—q DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> f1. Street Sd • Ci , USS,raD ,ItZ 10(5 <br /> z. SU"( 3I ( 5_ e- 5��/a 4 ly�Yr 4 ❑ Unit <br /> G SUee ( ! c C <br /> otyG deP V <br /> �J {. Stree I I r a L . AF ❑ Unit 2 q J tJ <br /> S. So-"t 3//33 t a v 'r Unit3 1 <br /> 6. S"e b (o ev L— (l G <br /> 7. Street Ci <br /> Unit 4 <br /> 8. Street G <br /> 9. street a (� <br /> lo, saes E El Unit <br /> 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ 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 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 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{8-02-006 <br /> 8/812003 <br />