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EHD LOG NUMBER <br /> DATE RECEIVED USAN JOAQUIN COUNTY <br /> FEK5 <br /> ` ENVIRONMENTAL HEALTH DEPARTMENT <br /> U 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> 2004 (209)468-3420 Fax: (209) 464-0138 Web:vrvw.co.san-joaquin.ca.us/ehd <br /> UG30I ` <br /> A <br /> gENI µ�A�1H PUBLIC RECORDS RELEASE APPLICATIO <br /> iV1R _ ,o <br /> pER nASGv jFNSEN BUSINESSIAGENCY: <br /> APPLICANT: ---- - 3 �h 76 <br /> ADDRESS: $$O X4 LU29, S�l7 <br /> PHONE: � n_G2a.N(O <br /> FACSIMILE: U9'�63h' 7y <br /> TENTATIVE`APPOINTMENT DATE: k5Af Time: v <br /> (Please allow 10 business days from date of application submittal) <br /> YC HECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> — DATE Q/Zl�d <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> FILE ADDRESS _ k1op � <br /> HI/way 4 Unit t <br /> 1. Street 70N •✓ <br /> z. street w rglrA6 � �Unit 2 <br /> 3. Siretl <br /> N <br /> Ci <br /> 4. St a Unit 3 <br /> 5. Street CJ <br /> 6. Sueet Unit 4 <br /> 7. SIree1 ^ <br /> Q <br /> e- StreM tl _u Unl <br /> 9. Street <br /> a <br /> 10. street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �{�SOUD W FACILITY <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) USING ABATEMENT OD FACILITY ,Ir OLID WASTE VEHICLE <br /> �ER CLEANUP SITE(NON-LOP) KENNEL iCI��AIRY <br /> ERGROUND TANK(MONITORINGIREMOVAL) ICKEN RANCH NUKG TREATMENT PLANT <br /> DOUS WASTE GENERATOR O7EVHOTEL .o��{ MPERTRUCKIYARDICHEM TOILETS <br /> RED PERMITTED FACILITY OVSPA LAND USE APPLICATION SITES <br /> TIERED <br /> PIERCING �0 POTHER(PLEASE SPECIFY) <br /> MEDICAL WASTE FACILITY <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 indica ed a o e. for review will be confirmed <br /> 2. EHD will notifythea licant if any EHD files exist. Anappointment he <br /> approximately five business days but no later than ten (10) days after <br /> receipt <br /> eishow dof pbe lication. <br /> Tledfiles <br /> will be held for a maximum of five business days for review. Appointments <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 /> iw <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 46-02-006 - <br /> 8182000 <br />