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DATE RECCIVro • EHD LUG NUMBER <br /> SAN JoaQt7zN COUNTY 10 <br /> ! Lr L i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"11 Floor Stockton, ca 95205 RO �� <br /> 3 1005 (209) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.cams/ehd 5 <br /> Ef�( 20'N"IB I HEN_l h PU13LIC RECORDS RELEASE APPLICATION <br /> APPLICANT:/�^Yl^7h �1�'moi.LG LO n , r� BUSINESSIAGENgCY:�� L I_� /,V,�n 't Y C. <br /> ADDRESS: '"170 G-_-1�i y, ws4-na I/�l�-, � ` S`q�t o r, <br /> PHONE: s5te'T -3-+p FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: GO (R(Q 5 Timo: �I ' <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 / DATE <br /> Department Use Only <br /> �e <br /> FILE ADDRESS UNIT <br /> 1. street 5,15-3 C. tM - J� • MIX F ❑ Unit 1 <br /> ], Street L 9 v m - s - 11 f7 <br /> 3. sV _, 6'1)U E • - DI p Unit IN1I�1 <br /> 4. Sl el 1 I�D - aly <br /> s. stroll 40 E <br /> s. aur SPU <br /> Unit 3 <br /> seal Skkxr_W)-�" g Unit4v. svccl <br /> e. Slrcct CI <br /> 9. siren cn ll Unit 5 <br /> 10. sheet a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> It OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> i�9k UNDERGROUND TANK(MONITORING/REMOVAL) ❑ bOG KENNEL d DAIRY <br /> HAZARDOUS WASTE GENERATOR ID CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKfYARO/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ 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 46.01-006 <br /> 010!2000 ' <br />