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ur.t r«l,r.i vtu .1.- <br /> SAN JOAQUIN COUNTY 1=Ha LOG NUMBER <br /> C ((`r ;'I�\t%/���� EN VIRONMENTAI., HEALTH DEPARTMENTE51 '—' 304 E Webcr Ave 3d Floor Stockton, CA 95205 <br /> ((209) 468-3420 Fac: (209) 464-0138 Web: www.co.san-joaqun.ca.us/ehd <br /> ppZZq <br /> 'E,F - EELTH PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSfAGENCY: <br /> ADDRESS: O ZLinG 70 <br /> PHONE:—_ J�p "'1�1 _FACSIMILE. <br /> TENTATIVE"APPOINTMENT DATE: -:'I Lk4L.(�qTime: f <br /> (Please allow 10 business days from date of appilaation submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-BEQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE U <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> suet SI e 3 . P . 9 k). S <br /> 2. Street 00 ' Unit 1 <br /> s. str�M S l <br /> 2-9 N .5j . PA,S9 T.J <br /> e. Sveet Gtv [] Unit 2 <br /> a street EJ n'a r 54-4-24-91 <br /> 6. strecl D pq. G , �-. ' Unit 3 <br /> ,,r J�• /', o,p,1 <br /> T. Sirmt t r . 1Z.^k. 1 ("fly .•'-1 7`L •1 "j� 4 <br /> 0� ICK Unit 4 <br /> 8. Srrent C. Ct ` n J 4 <br /> 10. street ' ,. ❑ Unit 5 <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILrrY <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Ci DOG KENNET, C3 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMrtTED FACILITY d MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> l7 TATTOOIBODY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Q 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 (2091464-0135 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 /> CONFIRMF-D APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> HHD 4a-6z Ot)a <br /> t;rar:aas <br />