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DATE RECCIVED . EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'a Floor Stockton, CA 95205 O 5F5 <br /> (i 1005 (209) 468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.us/elld <br /> ENViK0N11`IEAiI 11UVLAH PUBLIC RECORDS RELEASE APPLICATION <br /> Pr <br /> APPLICANT: YI 11 .. -C.D ' ^ BUSINESS/AGENCY:1 M'11 r)L .Lw n i <br /> //�� <br /> ADDRESS: "1 Q ✓I DWs+6o /VA-^� � 9, _L-� Q <br /> PHONE: JIQ�" '3 1 FACSIMILE: �� Z <br /> TENTATIVE"APPOINTMENT DATE: to�z LR S Time: 6 ' 0� <br /> (Please allow 10 business days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT _ DATE I D 1 v> — <br /> Department Use Only <br /> r '^^ FILE ADDRESS UNIT <br /> 1. SOMI I ) r •1'l Sl . Gt ❑ Unit 1 <br /> 2—s'et _e man S - CI r 'os <br /> a. 3o- _l 6111.,? E . I � cityS 0 �1 <br /> 9. 3Vee1 I � -.F—, <br /> - L.In - my <br /> 5. SVC D F—,_—Alm <br /> I miff� -" "e#,�y, � CJS J� �� <br /> e. Sired � l SIAr ltip- rl ✓w` . GN 5— WC- �P0 <br /> r. siree� Du Unit4 <br /> a. svice Oi <br /> s. svcm <br /> OR El Unit 5 <br /> 10. 5lreet CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 1( OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> (�{PL UNDERGROUND TANK(MONITORINGIREMOVAL) In DOG KENNEL tl DAIRY <br /> AZ <br /> HARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKlYARD/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 recelpt 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 /> END 4842-0a6 <br /> aronaoa <br />