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uu/unizuur W 10:A PAI ZUs40 M9 Sic FUBLlc WORKS 4002/002 <br /> Imo. -- <br /> �'"��t7E� I!D Cry; EHD LOG NUMOER <br /> �',''JImoI`�' <br /> �, <br /> H _,/ , i �, SAN Jont?uIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Sc �p 1fd v // 304 E Wcbcr Ave 3ie Floor Stockton,CA 95205 Q <br /> Ir (2p9)468-3420 Pax: (209)464-0138 Web: www.co.san joaquin.mu M 1 <br /> 0 \ EN'v'IR( , Po'!E�'? HEALTH 111111 <br /> ti AERN i/SERI/HS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Claudia Cemberling BUSINESSIAGENCY: San Joaquin County Public Works Department <br /> ADDRESS: 1810 E. Hazelton Avenue, Stockton, California 95205 <br /> PHONE; 953-7624 FACSIMILE: 468-2999 <br /> TENTATIVE`APPOINTMENT DATE: Tlme: <br /> (Please allow 10 business days(rein data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$'93.00nFEE-REQUEST PROCESSED IN 3 BUSINESS DAYS t <br /> SIGNATURE OF APPLICANT C� t R A�2iZt Xf.L( DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> .e cry u i-k q- 065 ❑ Unit t <br /> i Ob 00 aE5 ❑ Unit 2 \� <br /> Z 015-2 e <br /> Unit 3 <br /> C <br /> fLc7 c f tirn E5 Unit4 <br /> 4 Y'4Lf L'S ❑ Unit 5 <br /> ,o. srmm -]� 'Sr If'7 J2� QFl ca t <br /> J <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(U"CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OMER CLEANUP SITE(NON10P) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORIN=EMOVAL) O DOG KENNEL Cl DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL 13 PUMPER TRUCK/YARDICHEM TOILE TS <br /> 0 TATTOOISODYPIERCING 13 POOLISPA ❑ LAND USE APPLICATION SITES „ <br /> ❑ MEDICAL WASTE FACILITY 0 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 v <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 /> S. '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 /> CON EF�fnrtEtl' f�QfNr�i+1 �ATr <br /> M <br /> DAEE GONFIRMeDPHONE FAX It�171A1S. .. <br /> #Euit tnr�o Res: .N0 R 1AEKD;4j1'E, <br /> EHD 18-02L08 <br /> uenaw <br /> W i <br />