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DATE RECEIVED _ 1 t._ EHD LOG NUMBER <br /> /j�_, SAN JOAQUIN COUNTY <br /> ` ENV`I'RONMENTAL HEALTH DEPARTNIC'NT <br /> 0 C T 2 4Z� j 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> 209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/eNd <br /> PUBLIC RECORDS RELEASE APPLICAT3SW <br /> APPLICANT:n, /V1 � BUSINESS/AGENCY:�Y���v_P <br /> ADDRESS_3.�{ O C�(�(C-�h (DJ S rC�F�/NC(�O CA !25 123 <br /> PHONE:/-; q-0-3-20� FACSIMILE: V13-5R(_ 57g p 6 <br /> TENTATIVE'APPOINTMENT DATE: lti-T 30..203 Time: Ill-,/" ` <br /> (Please allow 10 business days from date of application submittal) <br /> W CHECK BOX TO EXPEDITE REQ ST- 3 FEE-REQUEST 0CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE a <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1 stmt T C QL, city `L Cy 1 t— ❑ Unit 1 <br /> 2. stmt W. l Ci .� <br /> street IL0 13 nk-V T�C— ci U VA �u <br /> l ❑ Unit 2 <br /> 4 Street l f1 `. C' � \ <br /> 5 Streel •�''It�1 eta o L G Q 3 <br /> 0. Street Ey— 1�1�f� Y LQ E't M y <br /> 2. street C �vUnit 4 <br /> B. Slrevt Ci <br /> 9. Street Ci <br /> 10 street C, Unit5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,�;kSjNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> B-UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> r:-`HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 1--f1ERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> "EDICAL 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 4"2-006 <br /> B/8!2000 <br />