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EMD LOG IJUMiDCR <br /> GATE RECEIVED SAN JOAQUIN COUNTY `..t <br /> I NVIRONM ENTAL JiLi AALTIEI DEPARTW.NT <br /> 304 Weber Ave 3rd Floor Stockton, CA,95205 <br /> 209 468-3420 Fay.: (209)464-0138 Web:www.co.san-joaquin-ca.us!ehdlo S TO <br /> pUBLIc RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> /•ADDRESS:�4D__Z in�� <br /> PHONE:- l/G ~/ FACSIMILE: .-_ <br /> TENTATIVE �I <br /> APPOINTMENT I? Time: � -- <br /> (please allow J0 business days from date of application Submittal) <br /> I—t CHECK 13OX TO EXPEDITE REQUEST_$93.00 FEE- EQUEST PROCESSED 1N 3 BUSINESS DAYS , /O <br /> DATESIGNATURE OF APPLICANT <br /> Department Use Ooh" <br /> FiLE ADDRESS UNIT <br /> �- (ra_ l <br /> t. Suaet • �_�a-��^Q� .� CN _ a '� ❑ Unit 1 <br /> S. Sfrect Gl ❑ Unit 2 <br /> A. Steet cityv7\� <br /> Unit 3 ✓ <br /> G, 5lttel • F a <br /> �. stren <br /> ct {a',,t1nilr4 <br /> f3. Strcffi CIt <br /> a. sty <br /> Ulty p Unit 5 <br /> to. Street Gt <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FiLES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) © HOUSING ABATEMENT © SOLID WASTE FACII-Ty <br /> OTHER CLEANUP SITE(NON-LOP) t7 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONFTORINGIREMOVAL) Q DOG KENNEL 13 DAiRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL Q PUMPER TRUCK/YAR0/CHEM TOILETS <br /> O TATTOOIBODY PIERCING C7 POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WAST;FACILITY 13 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 EHO 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 EMD 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 EHO staff. <br /> s. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMI~D APPOINTMENT DATi" TIME. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES . NO REVIEW DATE _ <br /> Gko 0-02-006 <br /> arsrzeoa . <br />