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N DATE RECEIVED - EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 / 2 <br /> uEc, ? � zoo (/f//J ✓7 <br /> (209) 468-3420 Fax: (209) 464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> ilUiLlii <br /> n S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> (� _)DBUSINESSIAGENCY: AhDA,91'1CU�ilbN bfrbt lul �I uoV <br /> \ N II <br /> -'�' � <br /> ADDRESS: 1425 V4eV 19nlz I)l l t', dt 26 i Sz c. Ci) Il Ins <br /> 31ng+1 <br /> PHONE: <br /> 91L r121-ij660 FACSIMILE: �I` (4YA W <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. Sneer 21710 M,uc-Rr.rHuy UnvC Cty Unit 1 <br /> 2. Street city <br /> 3. Street Q ❑ Unit 2 <br /> 4. Street Ci <br /> 5. Street Ci Unl <br /> 6. Street Q <br /> Ci nit 4 <br /> 7. Street <br /> 8. Street ZI <br /> Ci n °f ins <br /> 9. Street R ❑ Unit 5 <br /> 10. Street Q <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> LH'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 15 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Ir UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> d HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> 4p 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 /> 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 /> E <br /> IRMED APPOINTMENT DATE TIME <br /> ONFIRMED PHONE FAX INITIALS <br /> WED YES NO REVIEW DATE <br /> EHD 4"2406 <br /> NSM003 <br />