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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 00 <br /> ENVIRONMENTAL HEALTii DEPARTMENTu <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 1S � ' <br /> N0� 2 (2qt <br /> �( 68-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/chd <br /> ENV1Aom R� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ?2C,A- G"(�s BUSINESSIAGENCY: (' <br /> ADDRESS: 2- -/ /9 1 140 C`7— �r- /� CA- 3 <br /> PHONE: =0�- 7 E{, 10t,'-1 FACSIMILE: 2 y' 4` - -f3 J - <br /> TENTATIVE'APPOINTMENT DATE: Time: a�s <br /> (Please allow 10 business days from date of application submittal) �,"•'`-' <br /> CHECK BOX TO EXPEDITE REQUEST�93.00 FEEE�REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �'/h �' ' s DATE Cl q <br /> Department Use Only _ `O <br /> FILE ADDRESS n!° UNIT I� <br /> V`? t. so-ee 1-/7 Y. C -FULU 6h- YSJ <br /> o- E] Unit 1 <br /> 2. s `� <br /> 3. stree CRY <br /> ` sees Unit 2 <br /> s. weer a � W111 Unit 3 <br /> 6. $Uee <br /> 2!x MUM 16L6 U Uzu <br /> T. s"ea CAY unit <br /> 6. ski b [fin <br /> 9. saes( a ❑ Unit 5 <br /> 10. $a Oty 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY 411,1111111111111111, <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOBODY PIERCING ❑ POOUSPA �LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APP-OINTMENT DATE TIME <br /> DATE CONFIRMED `PHONE FAX INITIALS <br /> REVIEWED _ YES NO REVIEW DATE <br /> EHD 88-02-006 - <br /> 6/0/2003 <br />