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DATG RECCivzD EHD LUG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ,� - _ �l�,GJ ENVIRONMENTAL DEALTI4 DEPARTMENT <br /> 304 E Weber Ave 3`6 Floor Stockton, CA 95205 <br /> I :i' t 1005 (209) 468-3420 Fax, (209)464-0138 Web: www-co.san-joaquin.ca.us/ehd <br /> L=id1/iriUi:!I`1;t_'��i l HE L�H PUBLIC RECORDS RELEASE APPLICATION <br /> pr- 1". <br /> APPLICANT: <br /> [- <br /> APPLICANT: ^� J - G (� ^ BUSINESS/AGENCY: A/A l . 1A •A}-� <br /> ADDRESS: '"1 G�r1��NdW.S�0.X V)J L."L 191- 0 <br /> PHONE: ��-T '3 I FACSIMILE: (119 ` <br /> TENTATIVE"APPOINTMENT DATE: to LPATime: <br /> (Please allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ _ DATE I i 0� <br /> DeDartMOM Use Only <br /> FILE ADDRESS UNIT <br /> 1. street ytl�t� - rS�' • Gi S t F ❑ unit 7 ,)5 <br /> 2, rnet <br /> 3. slfal <br /> 6,111C 1r • / • cn S ❑ unit 2 <br /> at, S•7'a-L4e, <br /> 5. slro'( D • ✓Vl .: C aly L 02(� Unit 3 'I <br /> a. 3lre.[ Jtl• Sihc ✓' A'Y.Q ay S'�-C-tic, e2 (pQ <br /> 7. Sinai C1t Unit 4 <br /> 9. street qly <br /> 9. svam cfty ❑ Unit 5 <br /> 10. 51reet CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELRiOTEL ❑ PUMPER TRUCKlyARO/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIE <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 PATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 45-03-000 <br /> aonaa2 <br /> L <br />