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29 04 09: Sea Environmental Group 91( 48-5888 p: 1 <br /> DATE RECEIVED : EHD LOG NUMBER <br /> SAN JOAQUI[N COUNTY <br /> ENVIRONMENTAL HEALTH DEPAR'T'MENT <br /> 304 E Weber Ave 3d]Roor Stockton,CA 95205 <br /> C j_ (209)468-3420 Fax: (209)464-0.1 .Web: www.co.san-joaquin.ca.US/ehd <br /> a 04 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ' A_.:L �� BUSINESSIAGENCY: AaR <br /> ADDRESS: C Z <br /> PHONE: L Z.l'C1 FACSIMILE: K <br /> E'APPOINTMENT DATE: 1 z i O luu _ Time: 10D C <br /> (Please allow 10 business days from date of application subrnitta �E <br /> f4ECK BOX TO EXPEDITE REQUEST-$91-00 FEE_R26U T PROCESSED IN 3 BUSINESS D <br /> SIGNATURE OF APPLICANT DATE _ ro 0 `1{ <br /> Department Use Onto <br /> l� FILE ADDRESS UNIT <br /> s. street Ait- e i.7 ❑ Unit 9 <br /> 2, Street all11h• City 1mr-Liga <br /> 3. Street 4e- Unit 2 <br /> a. Street 0S <br /> s. suet+ ' fir► a Unit 3 <br /> s. stmet C p ` <br /> 7 Street G L C' Ufllt 4 <br /> a. sit 3 S <br /> CRY S6jC+1.p <br /> 9. sueet ❑ Unit 5 <br /> I! street 2 p` <br /> CS • LZ . µ..lm► P S � ,� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 6 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 4i3 OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY 0 SOLIDWV TE VEHICLE <br /> ID UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAI <br /> V HAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH E7 ENT PLANT <br /> W TIERED PERMITTED FACILITY 0 MOTELIHOTEL CIK/YARDICHEM TOILET'S <br /> E3 •TATTOOIBODY PIERCING ❑ POOLISPA E APPLICATION SfrES <br /> 13 MEDICAL WASTE FACILITY OTHER{PLEASE S <br /> 1. List up to ten addresses in the space above. Select the p 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 stays 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 APP61NTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX ' INITIALS . <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4"2-0116 <br /> EX2G03 <br />