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SAN JOA.QUIN COUNTY � EHD LOG NUMBER <br /> " ' IIZONMENTALHEALTH DEPAR't'MENT <br /> Ull V �C 304 E Weber Ave 3b Floor Stockton, CA 95205 <br /> (209) 468-3420 Tax: (209)464-0138 Web: www.co.san joaquin.ca.us/ehd �� <br /> MAR - 3 2006 <br /> E PUBLIC RECORDS RELEASE APPLICATION Z5 <br /> " L �0.�r(i11G.N BUSINESSIAGENC"Y:: ' �(tA f'c'�^O�R/�S!>\" .} �Sd C. <br /> ADDRESS: �d (� I l�lr).tJ �X (ADr .(n- 2-t� <br /> PHONE <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal) ;/00,0 <br /> 00 <br /> CHECK BOX TO EXPEDITE REQUEST-$9 .00 FEE— EOUE$T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE J cj_1b(Q <br /> Department Usc Only <br /> FILE ADDRESS - UNIT <br /> t, 91rcet � II�-. GI <br /> 2. 9lrael GI El Unit I <br /> 3. Sheol CRY <br /> A. slmm A. cl 1 0 F- Unit 2 J <br /> p (} p <br /> 5, Bacot P, F_�. 1 GI <br /> e. SlrcclGI /0'*Unit 3 <br /> T. shoot CI <br /> Unit 4 <br /> e, Flreel GI <br /> 8. street <br /> to, srceel C) Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT ❑!SOLID WASTE FACILITY <br /> 'GQ OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ar UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑!DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> }Q TIERED PERMITTED FACILITY q MOTELMOTEL ❑ PUMPER TRUCMARDrCHEM TOILETS <br /> Cl TATTOOIBODY PIERCING ❑ POOLISPA ❑ ;LAND USE APPLICATION SITE$ <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. EHO will notify theapplicant 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 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE �~ <br /> IlNv ea-az-0os <br /> uarzoa� <br />