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DATE RECCIVED <br /> • SAN JOAQUIN COUNT' 0 END LUG NUMBER <br /> /I' ' E+NVIRONMENTAI $EALTIDEPARTMENT <br /> 304 E Weber Ave 3"t Floor Stockton, CA 95205 <br /> (r : I 1 1005 (209) 468-3420 Fax. (209)464-0138 Web: www.co.sanjoaquin.ca.us/ehd 3F5 <br /> l_l PUBLIC RECORDS RELEASE APPLICATIONRO <br /> APPLICANT:/!] �GC-n BUSINESSIAGENCY:��yrt 67V1�♦ s�, .. 0 <br /> ADDRESS: -I()Z ltia(.�S'gr,�Q 1/L/q�,y (-.e-�.� 9,��•-t <br /> PHONE: FACSIMILE: 3 (R'ZI - q_ <br /> TENTATIVE'APPOINTMENT DATE: G-OJ�IR S Time: <br /> (Please allow 10 business days from data of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.Do FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1011 D� <br /> Dsaartment Use Only <br /> FILE ADDRESS UNIT <br /> succi S(53 yt�N� $} . al S �/ ❑ unit 7 <br /> ]. .i12el �D ter . I'1 Lin✓� O a f"� y �7 <br /> unit <br /> / <br /> s. slroaD �_„�✓V1p i,t,�C} Unit 3 <br /> a. Slral1 51P_ �. SiI�CJ QA✓' A'V-2 . aN � �C7I� r!'K e2 EPV <br /> 7. Slt , CII <br /> 8. Slrcet <br /> city <br /> Jund 4 <br /> 9. flmp, CI <br /> ❑ Unit 5 <br /> 0. a1roGi a <br /> tt <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILrTY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) In DOG KENNEL ❑ DAIRY <br /> 29 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRUCKrYARDtCHEM TOILETS <br /> ❑ TATTOO11300Y PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY in 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. END will notify the applicant if any EHD fifes 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 40-02406 <br /> W203 <br />