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DATE RECEIVED . . _ . .LFIU LOU NUnd,�trt <br /> ^1r�1tif h � SAN JOAQUIN COUNTY <br /> l <br /> V <br /> EN, IONMENTAL HEALTH DEPARTv1 LENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> SEP 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> cNVIR LEUd) HEALTH <br /> FRP� T <br /> oAiSFR1/ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> _ <br /> APPLICANT: A--',Vi}--/T BUSINESS/AGENCY: <br /> ADDRESS:_? � 7 C<I�di.t..'.1 /�v.V 3w;e. /"-7 11-Z'740 <br /> PHONE: G FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: /L U Time: }^!^ <br /> r <br /> (Please allow 10 business days from dale of application submittI) <br /> lzrp <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS v <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> h.N/, Cit e . <br /> N Street Z� L., (,'�io/,✓..-, }-r- Cit ,f-/-,�.,� / ❑ Unit 1 <br /> c — <br /> 3. Street Day <br /> ❑ Unit 2 <br /> 6. Street GI <br /> S. Street City <br /> Unit 3 <br /> 6. Street C' <br /> 7. Street C Unit 4 <br /> 8. Street Cn <br /> 9. Street Cit <br /> ❑ Unit 5 <br /> M Street Oily OCT _ 003 <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(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY 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 084)24106 - <br /> e162003 <br />