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ATE RECEIVED' EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />(�_ ENVIRONMENTAL HEALTH DEPARTMENT <br />" I `�`� DJ 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />AUG 1 3 20W9) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />EWIROM0ENT HEALTH PUBLIC RECORDS RELEASE( APPLICATION <br />APPLICANT: KikA•N Np'('PriuJo BUSINESS/AGENCY: J1fepr7yS E1� Jtf_ONMENIPrL, LNc, <br />ADDRESS: 3330 CAra6r•Or1 1'49-v- `bg., 4Y550 t_Ah-,CKA(J '1 prkX Ch �IS6gL <br />PHONE: 530 651'1- 600 FACSIMILE: 5'130 6J6 6005 r <br />TENTATIVE* APPOINTMENT DATE: g 1 1 3 10 7 Time: cs % d 0 n -s <br />(Please allow 10 business days from date of application submittal) OL (Z <br />PSIGNATURE <br />CHECK BOX TO EXPEDITE REQUEST - $ FEE - QUEST PROCESSED IN 3 BUSINESS DAYS <br />OF APPLICANT �Alt" DATE 98 I13 Ion <br />Department Use Only <br />51- ilz <br />UNIT <br />❑ Unit 1 <br />❑ Unit 2 <br />olwm.�I ,) <br />je Unit 4 <br />❑ Unit <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES `, `" — <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />FILE ADDRESS <br />❑ SOLID WASTE FACILITY <br />1. <br />Street <br />Z Z S <br />GO V N 1[ y L LA4 8 LA N I' Ci <br />$7 O LYyT ONV <br />2. <br />Street <br />2.S �J <br />cit( <br />1 ✓ <br />3. <br />Street <br />2.1 $ 2- <br />❑ <br />yy <br />4. <br />4. <br />Street <br />❑ <br />City4 <br />❑ LAND USE APPLICATION SITES <br />5. <br />Street <br />OTHER (PLEASE SPECIFY) <br />city <br />6. <br />Sheet <br />c' ty <br />7. <br />Street <br />Ci ty <br />8. <br />Street <br />Cit <br />9. <br />Street <br />Ci <br />10. <br />Street <br />c il <br />UNIT <br />❑ Unit 1 <br />❑ Unit 2 <br />olwm.�I ,) <br />je Unit 4 <br />❑ Unit <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES `, `" — <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ <br />FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ <br />DOG KENNEL <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />,41 <br />❑ TIERED PERMITTED FACILITY <br />❑ <br />MOTEL/HOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PIERCING <br />❑ <br />POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ <br />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 />sanooa zoos �7 £J�l F �� kr.g-12S CZ2L 4 �� (/�%�11z a �Z2l✓ly�L�G <br />