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Nov 03 05 03:14p Dar' Murray 408---9-1224 p.1 <br />pATE RECEIVED l rtEC�j� V E0 TO � NUMBER <br />11 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL Weber Vve 3 HEALTH DEPARTMENT 4W3 <br />304 E Weber Ave 3d Floor Stockton, CA 95205 <br />NOV — 3(5468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin.ca.us/ehd <br />WRON _2_'T NrrAccT PUBLIC RECORDS RELEASE APPLICATION <br />/yYO 1APPLICANT:('—M✓j Se✓VIC CS <br />ADDRESS: <br />k1'_`>0s.lDSCOh - <br />AU -Q I� So-yL�oSh��pCA95-I�' <br />PHONE:IZ�-/1S ID"lG—(o�0�- FACSIMILE: <br />TENTATIVE` APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submtUal) <br />CHECK BOX TO EXPEDITE REQUEST- $93.0 FEE -JAR/;R/U/E}ST PROCESSED INS BUSINESS DAYS <br />SIGNATURE OF APPLICANT �V v'f/V�Y�P 1 DATE <br />_:� __05 <br />Department Use Only <br />UNIT <br />❑ Unit 1 1 <br />3 sueei <br />4. Suet 1:]Unit2 <br />E_ Seee!Uy <br />FUnit4 <br />C sne <br />'59Nf <br />e. suer <br />e. suerCk ❑ Unit 5 <br />io. seee� cm <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACIUTY <br />OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL 17 DAIRY <br />HAZARDOUS WASTE GENERATOR U CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKNARD/CHEM TOILETS <br />O TATTOOBODY PIERCING O POOUSPA 0 LAND USE APPLICATION SITES <br />D 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 />6. "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 APPOINTMENT DATE TIME. <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />WD 4eaxaec <br />ue m <br />