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SAN JOAQUIN COUNTY <br /> EWONIMENTAL HEALTH DEPARTMOT <br /> 304 E Weber Ave 3°d Floor Stockton, CA 95205 <br /> APR 2 3 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.mus/chd <br /> LI H PUBLIC RECORDS RELEASE APPLICATION �VJ� <br /> APPLICANT:_C,45fY 7fNSEA/ BUSINESWAGENCY: Fl-)6E0 1&)e, <br /> ADDRESS: 2 B80 AJ. 7e4("Y ►x ,19 Su/7/ 7l4�"Y nlf 95 37� <br /> PHONE:_ 202- $35-06/6 FACSIMILE: 209- 835- 6575 <br /> TENTATIVE'APPOINTMENT DATE: A 997 T' <br /> ^�{/ (Please allow 10 business days from date of application sub <br /> J�'t CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED W 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A21 eGG DATE e112 3�� <br /> Depadment Use Only <br /> FILE ADDRESS UNIT <br /> x. sertet N a <br /> Unit 1 <br /> s2tr uY <br /> 4. soca ! J( ? 43 <br /> n Unit 2 itl <br /> s. sb"` ( S F Lf 710619 R P0 Unit 3 J <br /> a. s v E iAmp6r Wo4jq coy 4+7146)0 a� <br /> :. su,4 2/ _ ap <br /> a. -saee e p g�tuse Hw I <br /> LI <br /> 9. Shed Unit Unit 5 <br /> 4 <br /> io. sued <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITY " - <br /> OTHER CLEANUP SITE(NON4LOP) yFOOD FACa.R .¢f SOLID. SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONRS'YORINGAREMOYAL) DOG KENNEL CrDAIRY - <br /> S WASTE GENERATOR CHICKEN RANCH !F5KG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY Y'MOTELIHOTELUMPER TRUCK/YARDlCHEM TOILE" <br /> ATTO01BODY PIERCING PrPOOLISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFIC ((NY &LCS Eo>e S17(°5 <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 Tile 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. r 2 <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFdRME;DC' INTMENTDATE TIME :. <br /> t)ATECONFIRMED PHONE FAX INITIAL-S <br /> REVIEWED YES NO REVIEW DATE <br /> EHo 4e424oc- <br />