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LHU tali NUM MK <br /> 11 <br /> TE RECEIVED SAN JOAQUIN COUNTY - <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y'j ; ii [Oi)3 304 E Weber Ave 3`d Floor Stockton, CA 95205 I <br /> (209)468-3420 Fax: (209)464-0138 Web: www-cO.sanjoaquin.ca us/ehd <br /> PUBLIC RECORDS RELEASE APP]LICATIO�Nj� �n <br /> S �n <br /> BUSINESSIAGENCY: LC= / r� ��0 ^'V�ronmG� <br /> APPLICANT: Stocky 017 <br /> ADDRESS: S3 7�JS au> / a as <br /> PHONE: a07• FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> n'p fs - Time:q �V u ax-VI <br /> (please allow io business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE-REQUEST PROCESSED IN 3 13USINE n / <br /> SIGNATURE OF APPLICANT ent Use only <br /> U� Z <br /> FILE ADDRESS T UNIT <br /> f <br /> TM _ G ❑ Unit 1 <br /> z ❑ Unit <br /> a. SUelt f <br /> a. saea D Unit <br /> s. U� <br /> 3~ G •A i—o Unit 4 <br /> 7. 6o-eei <br /> City <br /> e. sueel �, ❑ Unit 5 <br /> 9. 51 e <br /> 10. so-tet <br /> V� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 11 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SIVE(LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH 13PKG TREATMENT PUNT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARO/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> O TATTOOIBODY PIERCING Ll OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking <br /> the appropriate box(es). 209 464-0138 or mail to the <br /> At least one file type MUST be selected. Fax to <br /> addrs indicated above. ointment for review will ba confirmed <br /> 2. EHD eswill notify tho applicant if any EHD files exist. An app <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 /> y being worked on by EHD staff may not be immediately available for review. new <br /> 3. A file that is activel <br /> aPPlication may be submitted when the fila is available. <br /> 4. Any file not aymed in the same condition as released will b®reorganized by EHD staff at the expense <br /> of the applicant. Future file r®views 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 /> g- Applications received after 3:00 pm will b0 processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> ZHO 4942-M <br /> mom <br /> TO/T0 39Vd 1,101NOOIS 39V 811TL9CGOZ OT:ZT £00Z/81/80 <br />