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DATE RECCIVFD • SAN JOAQG)N EHD LUG NUMBER <br /> COUNTY <br /> ENVIRONMENTAL HE <br /> ALxI DEPARTMENT <br /> 304 E Weber Ave 3'a Floor Stockton, CA 95205 7005 (209) 468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.us/ehd qO 5F5 <br /> NVVhUP.! le til I! u H PUBLIC RECORDS RELEASE APPLICATION <br /> PG. I;.,' .,. '�� (� p <br /> APPLICANT: k <br /> �- 6,A 1'--0.GG.D(� � A, BUS'INESSryIA.GENpCY:'I L�pa l � Jn,�n 't <br /> ADDRESS: '"1�2 �v�Ow.S q�WAI'A �-.>� `S2-{ 0 <br /> PHONE: FACSIMILE: 3 (a ` <br /> TENTATIVE"APPOINTMENT DATE: G'O��i(."PASS Time: GI ' CID <br /> (Please allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$73.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ID 1 C)� <br /> Department use Only <br /> FILE ADDRESS UNIT <br /> i. SOMI S(53 vt1 St • at S ❑ Unit 1 by <br /> 2. SVeel C �1 <br /> 3" SUMI 5 I I— . city S ❑ Unit 2 <br /> 4. Sine I O-UD _ oly - p/1 <br /> s. soca D �✓� 1 - C •� a J tJ ')w/ Unit 3 <br /> e. stftl ��. dlt'�G,L¢GV' rJ.✓�` city S-i VtJt•' 73.1, <br /> i. siroel 0° Unit4 <br /> 8. Sire01 a <br /> ❑ Unit 5 <br /> 10. Slreel a <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 t] DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMMED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKIYAROICHEM TOILETS <br /> 173TA7700I800Y PIERCING C3POOIJSPA 71 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 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 /> EHD 40-02406 <br /> WWO02 <br />