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NAN J OAQUIN (AUNTY <br /> ENVMPNMENTAL HEALTH DEPARTM#T <br /> !a 304 Weber Ave 3d Floor Stockton, CA 95205 <br /> 5 Z(q�9)468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/chd APR 1 7 <br /> 1,ENLTH /� PUBLIC RECORDS RELEASEE AP/PLICATION y <br /> APPLICANT: SfP,w agc -r4-e'r BUSINESS/AGE/N'CY:_�7�1"c(,r'Li�S <br /> ADDRESS: 3.3. �.�.i�1P,c^CYl �(,/'.� ��, L-e, SL-vfe j,�d �. <br /> 'mP avl , cI SG <br /> PHONE: Jr3b -676—e/'G6 8 FACSIMILE: 5.30 6 76 -6 0U S <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittao <br /> CHECK BOX TO EXPEDITE REQUEST-$91.00 FEES /.✓"EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I 0� <br /> Department use Only <br /> FILE ADDRESS UNIT <br /> 1. svKe 3423 ssf <br /> 2. s �'-a v1 5 u" ❑ Unit 1 3 ' � <br /> 3. Suee1 I V . c VST <br /> —;77-i <br /> j <br /> 4. Streeet LitD Unit 2 <br /> F vUl e sfyee.F usX <br /> s. su -9 ZS-L S 13 Unit 3 3 <br /> s. sunv '1 e/ s; <br /> r. scree X10 G , /61iv124' L4sr V N D nit4 <br /> a. SIM us'T <br /> 9. Sant _ 6 t' rotSf_ ,5r ❑ Unit 5 <br /> City <br /> 10. so- <br /> R 1 1I' rls� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY _ <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIF`!) <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(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. r <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENTDATE _. :.. TIME <br /> DATE CONFIRM ED `PHONE FAX `. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD"Z24" <br /> Y6r2001 <br />