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_ ... _.. ., EHD LOG NUMBER DATE RECEIVED - - -- � - — SAN JOAQiTIN COUNTY ` ENVIRONMENTAL HEALTH DEPARTMENT 4� p4 304 E Weber Ave P Floor Stockton, CA 95205 SEP 2 2 2 a5 gZ09)468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin.ca us/ehd Ar ENVIRU, i i1 RLTN PER 14!':':':^.:iCES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: - BUSINESSIAGENCY: ADDRESS: IJy L-71-I l I/1^1( 44E5 t-� PHONE: n7 SIMILE: sloes ee(I �Jeeds �} TENTATIVE'APPOINTMENT DATE: Time: /,��"""/// a y (Please allow 10 business days from date of application submittal) �iyl tR CHECK BOX TO EXPEDITE REQUEFEE-REQUEST P IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT / DATE Z Department Use Only FILE ADDRESS UNIT I. steer ) CRY ❑ Unit 1 2. Strad 1✓- IQCe- City , a. sued a ❑ Unit 2 C)� � Strad Ci 5 sueda Tnlit3 6. Street e. Street Q s street city cf;�smu ❑ Unit 5 10. Sued G 9nd b; r. ENVIRONMENTAL HEALTH DEPARTMENT FILESt 9 ` �- �'11NDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 SOS SING ATEMENT 13 SOLID WASTE FACILITY Pt.OTHER CLEANUP SITE(NON-LOP) �LF'� ❑ SOLID WASTE VEHICLE )EL UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS ❑ TATTO01BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10)days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit Brio r vl W. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business days e CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EHD 4842-006 6 003