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EHD LOG NUMBER <br /> DATE REGENED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 30ve3 HEALTH DEPARTMENT95205Z01?3 <br /> ll�� � .� 2004 304 E Weber Ave 3"I Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www•co.san joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jb -j'9 tnBUSINESSIAGENGY: <br /> .cdc //^� ��-- <br /> 'ADDRESS: O.T�G(n $�Y"C.`K.T SCv-,. I.�A ( } <br /> PHONE: g�0 FACSIMILE:—10'4 gJ3 `�V . <br /> TENTATIVE'APPOINTMENT DATE: <br /> ll 15 t7� Tlme: ";' 00 <br /> (Florio allow 10 business days from date of application submKtal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST•$03.00 F\EIf-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `� ,,, DATE <br /> Depanment Uso Only <br /> 9,,+ <br /> FILE ADDRESS <br /> ad � <br /> z son O a <br /> 4. 9"p a c ���A <br /> c,Steel <br /> Cq L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTH ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDER ROUND TANK Srfr <br /> ❑ DAIRY <br /> HAZARDOUS W TANK GENERATOR <br /> A DOG KENNEL PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENFJ2A70R O CHICKEN RANCH p PUMPER TRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY 0 MOTELMOTEL <br /> ❑ POOL/SPA IC e LANDP9E APPLICATION SITES <br /> • TATTOOIBODY PIERCING V OTHER(PLEASE SPECIFY) I YY Z <br /> ❑ MEDICAL WASTE FACILITY �uT <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0139 or mail to the <br /> address Indicated above. <br /> 2. EHD well notify the applicant rf 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$83.00 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 T <br /> OlN2003 <br /> £686 B£13 602 : 'ON 3NOHd slsFlpud o.2az punoug WOW <br /> Td WdS2:T0 6002L2 '400 <br />