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1't 29 04 09: 58a Environmental Group 914348-GGBS p. 1 <br /> ATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-013-8.Web: www.co.san joaquin.ca.us/ehd <br /> CCT .' J ( U' Z01?9 <br /> y PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A, LUI BUSINESS/AGENCY: kb <br /> ADDRESS: 04-T17-0 <br /> PHONE: to ' Z.%-O FACSIMILE: x/51( ` <br /> .IAF VE`APPOINTMENT DATE: t �� T'� 0 1 Time: 000 <br /> (Please allow 10 business days from date of application submi <br /> ECK BOX TO EXPEDITE REQUEST•$93.00 FEE—F(; )U T PROCESSED IN 3 BUSINESS D ll (91 y <br /> SIGNATURE OF APPLICANT L!. � DATE <br /> Department Use Only <br /> /FILE ADDRESS 1 UNIT <br /> /, <br /> 1. sweep i� A.I -Ita c k o <br /> z, sweat <br /> tom, A'ss' <br /> J City ❑ Unit t Jl <br /> 3. SUW Q S A,.k U <br /> nit �) <br /> 4. Star 08 11 c c \x,1\0 <br /> 5. suer • YtA CIN <br /> 6 sweet G .-� <br /> z. sweat f-. L G <br /> a. sweet t3r_ cit <br /> e. S"coly ❑ Unit 5 <br /> 10. serer Z 1 M A., oty <br /> • }LZ . f 1..1�+ <br /> hie.- <br /> ENVIRONMENTAL <br /> Dc ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 19 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID W TE VEHICLE <br /> IM UNDERGROUND TANK(MONITORINGIREMOVAL) CIDOG KENNEL ❑ DAI <br /> III HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ ENT PLANT <br /> 91 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL P CKrYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING O POOUSPA VSE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY CI OTHER(PLEASES <br /> 1. List up to ten addresses in the space above. Select thus)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 (1D)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 /> EHD B42-006 - <br /> HIM000 <br />