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9r. � <br /> ' 9AfirTk9tEIVED - EHD LOG NUra�EER <br /> _ ,�,:- ;;; ,;�� ;- , SAiv.7oAqu>rf COUNTY ��� <br /> L � ENVII201`MENTA1,HF.Ax�7rH DJEFA RT1V1ENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> APR 2 7 2GG6(209) 468-3420 Fax: (209) 464-0138 Web: wv w.CO.MrI joaquizl.ca.us/ehd <br /> ENVIRUNIy'IEW HEALTH <br /> PEBMILSERVICES PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: �Clll/A C�np� �y BUSINESS/AGENCY; <br /> ADDRESS: <br /> PHONE:-Vt' 3&&97-5-70 ` FACSIMILE: �q ,% 22 — <br /> TENTATIVE"APPOINTMENT DATE: ROU 4-CO Time: <br /> rrqq (Pleaaa allow 10 businass days from date of application submittal) <br /> L_I 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 /> s4cer I N an J � � D Unit 1 <br /> 2. Slrael I� n./. /�.r�.rS��J,,.�C/�V-w y�% / <br /> 3. 5VCet Q1 �� fry 1 "L�LJtiA.� cl q��/(/W.M1' �" ( f"'1 Un 2 <br /> 51_,r9 <br /> 1_,r +-( kgr ,, d2,a cIM <br /> S. 31m0I cue . Unit 3 l <br /> a, Street <br /> T. P=1 GNj Unit <br /> B. s".4 Giv <br /> s. Sueei c5 Unit 5 <br /> to. Slree� G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 19'OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 5/UNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL n DAIRY <br /> 15/HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> L� TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRVCKfYA.RD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <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'aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209464-0138 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 /> S. "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 /> EMP qE-04-0BS — <br /> NM003 <br />