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EMU LOG NUMDErl <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> CNVIRONMENTAL HEALTH DEPARTIVIFNT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205(209) 468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin.ca.us./ehd Z 35TO <br /> PUBLIC RECORDS RELEASE APPLICATION (((/// <br /> C�/� BUSINESS/AGENCY: /V II( D t � <br /> APPLICANT: t � vv�� ���.J,,,� ,, JA� (� , <br /> ADDRESS: 1�__Z Ih }, �`' I�1J-�/X(•- �r <br /> �IIG� -3 1 y i - FACSIMILE:74 n�C9-1 — 1-7- <br /> PHONE:. <br /> TENTATIVE'APPOINTMENT DATE:571� O Time: t \ <br /> (Please allow to business days from date of application submittal) <br /> CHECK 730X TO EXPEDITE REQUEST-$93.00 FEE- EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,� �! DATE <br /> Department Use 0 <br /> 11 <br /> Y <br /> FILE ADDRESS <br /> - UNIT <br /> t. street `AL�G.O�.� Gy w_51'� ❑ Unit 1 <br /> c@i �'dsl¢� <br /> c <br /> 3. Flak( Gl ❑ Unit 2 <br /> A. 54eet CI zsy �,yy�eapa \ <br /> W sy .t4Y� <br /> e. SlRel G f, < p sF •T�<x'`u,. <br /> r Ere„ G Unit <br /> a. slm8 Gt <br /> 9. sr'., G ❑ Unit 5 <br /> 10, stmet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )11 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O ROUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> y' OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MOMTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUGKITARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLJSPA ❑ LAND USE APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIMI <br /> 1. List up to ten addresses In the space above, Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 /> G. 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 /> rHo�aaxaos <br /> aerxaoa <br />