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DATE RECEIVED ' EHD LOG NUMBER <br /> 71� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> dd 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> S E P 3 0 20 /f <br /> Q209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquiquin.ca.us/ehd <br /> �1EALTH <br /> Fr ;, . dICFS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:-S 1A \ �r rjA✓LL-Z.BUSINESS/AGENCY: <br /> ADDRESS: S <br /> ,,,,� ^ ��j�� <br /> PHONE: 4- 4` -7 6 d'Y f_'ACSTMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittaD <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROC SEF�S �I,�' N�NESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 35 tt,. street Lj Unit 1 <br /> 3' stree k I <br /> 3. Street ❑ Unit 2 �(�y <br /> .. � G is <br /> s. stree Unit 3 t� ) <br /> 6. Street D' ' �_ <br /> r. Street Unit4 <br /> 6. s reel <br /> 9. street G ❑ Unit 5 <br /> 10. SUeet c' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WAS F CILrrY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> T6_UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0—HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 16 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ 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 p <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 DATE _ TIME <br /> DATE CONFIRMED PHONE : FAX ANITIALS' <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 <br /> 8/61200] <br />