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DEHD LOG NUMBER <br /> ATE RECCIVEp <br /> SAN JOAQUIN COUNTY • <br /> E'N'VIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"'Floor Stockton, CA 95205 103 <br /> I i 1005 (209) 468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.uslettd <br /> eiV�l{�i0P1P1,El�i1 FIUJJiH PUBLIC RECORDS RELEASE APPLICATION <br /> /�TLBUSINESS/AGENCY:APPLICAT: ' ^k, W _& D 62 <br /> ADDRESS: �A)ne (21v 191_q0 ,. <br /> {j <br /> PHONE: c��'T ' FACSIMILE: �� <br /> TENTATIVE"APPOINTMENT DATE: Time: 9 ' 0_0 <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-Ss3.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� DATE <br /> Department Use Only <br /> FILE ADDRESS F UNIT <br /> I. strMt 515 . yW�\ - �S} . Gt S r ❑ Unit 1 �5 <br /> 2. Steel e- . 1'1 A - eI �t 1 <br /> a. slrecl 1 I�n at S•i-a-tla ' Unit 2 ��' � <br /> s. slrc i D JI l�x v� C• alY �}s °Z� Unit 3 <br /> B. $1rM1 N• Sihcjg�+Y�i'`l GH <br /> ]. SACCI CIt Unit 4 <br /> 8. Slrctl CI <br /> s. alp of 17 Unit 5 <br /> �I <br /> 10. Sheet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> yL� OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ;k UNDERGROUND TANK(MONITORINGfREMOVAL) ❑ DOG KENNEL t7 DAIRY <br /> ff�eij H 'RDOUS WASTE GENERATOR MOTEL <br /> ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY E3 niOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO1800Y PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Cl 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 /> addressindicated above. <br /> 2. EHD will <br /> 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. Anew <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 PATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Ell 4812-001 <br /> aronaoa <br />