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DATE RECEIVEDF,HO LOG NUMBER <br /> SAN .TOAQUIN COUNTX • <br /> ENVIRONMENTAL HEALTkl DEPAR'T'MENT <br /> 304 E Weber Ave P Floor Stockton, CA 95205 <br /> (209)468-3420 Fay,: (209) 464-0138 Web: www.co.san,joaquin.ca. el>J�� (x� <br /> PUBLIC RECORDS .RCLEASE APPLICATION( 1 <br /> (7 f" <br /> APPLICANT: rj 1��-sa_.4•�D BUSINE/SSIA�IGFNCY:AW1 f7. & ,�.uk0-N `f" -fts'it-C . <br /> ADDRESS: zz-gql����--�LZ_ICK;f �S 1 A W G l..Q'�+ GI��', o r� <br /> PHONE: iJIR1 ��) FACSIMILE: %Q <br /> TENTATIVE'APPOINTMENT DATE: ( � 1 �' Time: 6a <br /> (Please allow 10 business days from date of application1 <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCES U 1 DAYS <br /> SIGNATURE OF APPLICANT G DATE <br /> Department Use Only <br /> FILE ADORES$ UNIT <br /> Ir of 2910 wUt O I \TA. <br /> 1� z, simm 2-�'� E <br /> Q . o c ❑ Unit 1 <br /> strr�T � SYS �s It a t Crf1 0un)t 2 <br /> r 11 snml 'n5 P4 - e 1 6 I Unit 3 <br /> \G 6. Sireel ,Iztzo ��vw�. ^ K0 64( <br /> v\\0. s'mel {'31 P 'L1 s ' WaGwn , <br /> t aG"S sl of ld6 1 Unit <br /> Slrccl �5�" ,� c$�� rl <br /> \ 0 . s.r 21 fro I^ll° V oSa P*9 . r <br /> Unit 5 <br /> t, 3tolo3 Pew saw • 0 <br /> ENVIRONMENAR t NT FIL <br /> W UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 9 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> tQ UNDERGROUND YANK(MONITORINGIREMOVAL),/ O DOG KENNEL ❑ DAIRY <br /> 8�Se HAZARDOUS WASTE GENERATOR-" [73 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> I'-^ TIERED PERMITTED FACILITY✓- AoAb O MOTELINOTEL ❑ PUMPER TRUCKIYAROICHEM TOILETS <br /> P TATTOO/BODY PIERCING 0 POOL)SPA O LAND USE APPLICATION SITES <br /> M 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> slerton� <br />