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OATS RECCN60 • SAN JOAQuEHD LOU NUMBER <br /> >;N COUNTY <br /> ur ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'a Floor Stockton, CA 95205 O 5F5 <br /> y005 (209)468-3420 Fax. (209)464-0138 Web: www.co.san-joaquin.ca.us/ej1d <br /> eNll;RUPJF�°,tJ�iT HEALfIt PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: m c-o SUS�INESSryIAGENpCY:'�,a I 41'Nc� J.,_,zmn T 'fi"6. t>'❑ f_ <br /> ADDRESS: '-1�2V" -— I A'us+' I/� L-8"'x--t ` 'S�-t Q <br /> PHONE: �>iQ�"3 "r FACSIMILE: 3 619 ` 4 <br /> TENTATIVE"APPOINTMENT DATE: VD [R(0 Timc: ' 0� <br /> (please allow 10 business days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT p DATE ID 1 0f <br /> Denanment Use Only <br /> FILE ADDRESS UNIT <br /> sacci 5153 yvyt7� Sf . G, S ❑ Unit 1 h5 <br /> x. Street I'1 - 01y '11 <br /> s. suaa 5 1 1✓ • ai SD Unit 2 <br /> 4. suer 1 GiSD I�n . air { a r It <br /> s. suoct D er— ✓419 /'�� Cj ualla �' c a U Unit 3 1 tF i <br /> 9. S,rcd ,JV• SlNGygdJ Iq"v` - <br /> �, cltUnit 4 <br /> 9. slrztl a <br /> ty <br /> e s�«m cn it Unit 5 <br /> 10. Street 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 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARWCHEM TOILETS <br /> ❑ TATTOOIHODY PIERCING ❑ POOIJSPA ❑ 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 w111 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 48424OG <br /> OW03 <br />