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AUU. Z 1. 1UU4 4;4UFM `'()NDUK EAK I H I ECH NO. 6355 P. 1 <br /> DATE RECEIVED <br /> R � �` SAN JOAQUN COUNTY EHD LOG NUMeF-R <br /> �CICJ�`�� '=D FNVMONMENTA.L HEALTH DEPARnaNT <br /> 304 E RTeber Ave 3'Floor Stockton, CA 95205 <br /> AUG 2 7 20t��9)46$-3420 Fag: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> EppFF wLcNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Z UCANT. 4.r1 kko- S 13USINESS/AGENCY: 0 &-4,L � /GO�o 'e-5 TL4c� <br /> ADDRESS: u S T (L 20�o -y� <br /> PHONE: D — Z3 -os,/8 FACSIMILE: 2-00 2. '� 0 Z 3$ <br /> TENTATIVE`APPOINTMENT DATE: IO s¢ tr xp0 Time: a AAA <br /> (Plaaee allow 10 business days From data of application aubmlttal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE- RE EST PR ESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /7--it lo 4 10 <br /> 04artrneA Use Only <br /> FILE ADDRESS f UNIT <br /> +, Sl eel areGAA , Gl Sfac(c <br /> 2 su.. 4 SElUnit 1 7 <br /> 3. Stmel 7-4Cil U �!i <br /> J <br /> 4. 3ueec it, <br /> 0 /-70M <br /> 1 L <br /> s. suvec $ o a Unit 3 \\ <br /> G <br /> 7. 6oeet DE5 50i)1 <br /> a sum 1 1'1 c G -5-r.,74 Unit 4 <br /> 0. 56sW <br /> Gl <br /> 4W i-- <br /> 10. Suaet ,� � GMW <br /> ❑ Unit 5 <br /> L cily t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT CAJRY <br /> OLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY OLID WASTE VEHICLE <br /> 1XUNDERGROUND TANK(MONITORING/REMOVAL) C3 DOG KENNEL <br /> 'ice HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> -TIERED PERMITTED FACILITY M MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING -❑ POOUSPA -- - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY t3 OTHER(PLEASE SPECIFY) <br /> �• 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 /> �. EHD will notify the applicant if any EHD files exist. An appointment for review will be Confirmed <br /> approximately five business days but no laterthan 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 /> OCIApObINT IST VAX, ': <br /> . " <br />