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c <br /> +' - EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> "r1�\\lit. '•.,i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> 200 <br /> pCT 11 (2409)468-3420 Fax: (209)464-0138 Web:waw✓.co.san-joaquin.ca.uS/ehdV,('[`,/�(�/J <br /> ty,Itr ' t �tt5 PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT. Y''V BUSINESSIAGENCY: <br /> ADDRESS: 010L '' 6L <br /> PHONE: <br /> 7)��- FACSIMILE: <br /> /C4 <br /> Time: <br /> TENTATIVE`APPOINTMENT DATE: <br /> V <br /> (Please allow 10 business days from date of application submittal) <br /> 5� CHECK BOX TO EXPEDITE REQUEST-$93.00 FEEREPROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT Department Use Only <br /> FILE AD/DRESS UNIT VC <br /> 1. Street D-. IV, t�C�, Z n _ Lo El Unit 1 <br /> 2. street 3t-43� S. Air avk W S'Ta c.kt6h• V <br /> ZIA <br /> 3. street 2(0 S1 S, gtivon-k W G Skecic� X117 t r/ � [] Unit <br /> .. street 511' L• m 0�1 n <br /> 5. Street 515 G, M ;V S�. G S fz c t� ti /Jf Until <br /> 6. Street 2/ �, C5l/G/Y�S4tnj <br /> SJm�f`- Unit <br /> v� ��. <br /> B. Street '�`�� �' �n�n"{' S-�vcl�.Fti1-. Unit 5 <br /> 9. Street r}S 1 S E l t U^Y\ S'� ./}�,� G l,. r 1 p� n� <br /> 10. sree �1 ) N. �n1'i�� r1 • G Sib 4 <br /> 9 nn L Jct ENVIRONMENTAL HEALTH DEPARTMENT FILES pC� <br /> ;7 <br /> �. ❑ SOLID WASTE FACILITY UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> ❑ DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <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(east one file type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address indicated above. <br /> HD to <br /> 2. EHD will notify the applicant if any Efiles exist. appointment for review will be confirmed <br /> o later than ten (10)days after receipt of application. The files <br /> approximately five business days but n <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. Anew <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 re 'e l <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 /> 'PHONE FAX" INITIALS <br /> DATE CONFIRMED ' <br /> REVIEWED _ YES NO REVIEW DATE <br /> EHO 48-02-006 - <br /> 8/8/3003 <br />