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OATG P,ECCIV$D EHD LUG NUMBER <br /> SAN JoAQt�zN COUNTY <br /> L Ilii ENVIRONMENTAL HEALTII DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 Rio <br /> 3F5 <br /> (209) 468-3420 Fax; (209)464-0138 Web: www.co.san-joaquin.ca.ustelid <br /> ENVIRUPUvIEhI I HEAL-1I1 PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT: 46.A 1 r� BUSINESS(AGENCY:� " I1)ti_ pl dj ,&mn t Al RPh„ <br /> ADDRESS: "/DZ 5 1{ 0.�WGt��1 � `ggLjLc) f; <br /> PHONE: LIQ�" � t FACSIMILE: 3 tog - 4_2_ " <br /> TENTATIVE"APPOINTMENT DATE: toT S_ Time: 6 <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 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. SVttt S 153 y1�M sk • aI S r F ❑ Unit f <br /> a. strati 571a S ❑ �1 <br /> unit 2 1° <br /> I. 3b et 1 0-M al s 1) <br /> 5. so-cd b .I _✓� I� St al .`��o, L,-rla� Unit 3 <br /> 9. strcN ry. SIVNC1F.dY aH <br /> 7 Sl�t clt Unit4 <br /> 9. slrctt city <br /> 9. MIMI Illy El Unit 5 <br /> 10. 51reet CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> `110 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 C7 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 11 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILFTY ❑ MOTELITIOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/600Y PIERCING ❑ POOIJSPA ❑ 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 /> EHD40A2409 <br /> M002 <br />