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DATE RECEIVED tt-1u LUh(�uwiuLl� <br /> SAN JOAQUIN COUNTY <br /> ENN__.ONMENTAL HEALTH DEPART_ ._.;NT <br /> HH_AI-1 1B04 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> 03 AUG 13 AM WALIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t6 r BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE: ��l — `7`�l� FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: ACk � - Time: <br /> (Please allow 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—RE UEST PR CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Ze/70C DATE <br /> c Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. Street D f __77 t/) /�[ city <br /> ❑ Unit 1 <br /> 2. Street L/ice ry e< D _?O-)V Ci" <br /> 3. StreetS� 3l) Cit ❑ Unit 2 <br /> 4. Street R 1 G rD 3G241' cit - 3I--,) <br /> 5. Street �e�p r% r1 �l Cit l -- Unit 3 <br /> 6. Street aS Cit <br /> rr � �J <br /> 7. Street �✓D ACil Unit 4 <br /> 8. Street Cit <br /> 9. Street City nit 5 <br /> 10. Street Cit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> l( UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 't UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ 'PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 /> EHD 48.02-006 <br /> 8/8/2003 - <br />