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GATE RECEIVED 0 SAN JOAQUIN COUNTY EHD LOC, NUMBER ENVIRONMENTAL HEALTII DEPARTMENT 304 L Weber Ave 3rd Floor Stockton, n- 9520 (209) 468.3420 Fax: (209) 464-0I38 Web: www.co.san- ca. e �Y _pp_ (�Q,,,�� ((( PUBLIC RECORDS RELEASE APPLICATION PPL.I /C� ATION ((��•• APPLICANT: �y,L� D BUSINESS/AGENCY: - y� -f- ADDRESS: tADDRESS: PHONE: 3& -571-v 1 FACSIMILE:_ TENTATIVE" APPOINTMENT DATE: (� LI 0 (PleaSO allow 10 business days from data of .1ppliCationAoftl CHECK BOX TO EXPEDITE REQUEST- $93.00 FEE — REQUEST PRocEsj U&1 DAYS SIGNATURE OF APPLICANTDATE (�[S' 07 Dcoarlmcnl Use Only UNIT Cl Unit 1 0 Unit 2 Z Unit 3 1664,V unit 4 FILE ADDRESS Unit 5 sroci 217-te E - L<m . •. o c 1-�. ��m�� 2 -sP-et/�• Lam. 3 I 1 V art SlrCnl -517 6. Stmel �Sf I-�I �� 6yy-��[�W-n -T�.yn r� no slmtt ,/ p •'^r' l I AA^ 0 S 2 int 6 I s0eam 0, slml z��"7) n C $ e" I of al 9-0 lM� �o5c" P --.Q. f veM 'x'f. � UNIT Cl Unit 1 0 Unit 2 Z Unit 3 1664,V unit 4 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 EMD staff at the expense Of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE MHO -"42-466 8/011003 Unit 5 t • 3tnlo 3 Y�4xeh. . 2 f t ENVIRONMENT H TH DEPASR NT FIL UNDERGROUND TANK (UST) CLEANUP SITE (LOP) IC OTHER CLEANUP SITE ❑ ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY (NON -LOP) IC UNDERGROUND TANK (MONITORINGIREMOVAL)✓ 'Rt ❑ FOOD FACILITY DOG KENNEL ❑ SOLID WASTE VEHICLE ❑ DAIRY HAZARDOUS WASTE GENERATOR✓ TIERED PERMITTED FACILITY ✓- norlt ❑ ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TATTOO/BODY PIERCING ❑ MOTEL/HOTEL POOUSPA ❑ PUMPER TRUCK/YARD/CHEM TOILETS ❑ ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY)_ LAND USE APPLICATION SITES 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 EMD staff at the expense Of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE MHO -"42-466 8/011003