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' DATE RECEIVED SAN JaAQunv COUNTY EHD LOG NUMBER <br /> COUNTY <br /> a ENVMONMENTALME <br /> HEALTH DEPARTMENT 't N Q V+ 1 ,S <br /> 304 E Weber Ave 3dFloor Stockton, CA 95205 '5V ��O <br /> -2cN )468-3420 Fax: (209)464-0138 Web: vnww co.san joaquzn ca.uslehd <br /> �l > PUBLIC RECORDS RELEASE APPLICATION Io 3 S <br /> ' <br /> APPLICANT s� l <br /> T11n�/ �e BUSINESSIAGENCY <br /> ' ADDRESS 1 V\ S-T t 3 S <br /> PHONE —SS S ZZ" ]` N, 'A - - FACSIMILE. <br /> - TENTATIVE"APPOINTMENT DATE- -J l S+i A ,lc,,Nc,- � <br /> (Pisase allow 10 buslnesss days from date of applicaUan submittal) <br /> ' ❑ CHECK BOX TO EXPEDITE REQUEST-$93 04 FEE–REQUEST PROCESSED IN 3 BUSINESS BAYS <br /> rCk <br /> SIGNATURE OF APPLICANT DATE 1 <br /> Department Use Only <br /> FILE ADDRESS UNT <br /> I west ` 1 O C a. tri 0\ a S'( J C :3 <br /> z stent 1 cl r c a v! ❑ Unit 1 <br /> 3 street a p Unit 2 <br /> 4 Sveet city <br /> ' 5 strew ❑ Una 3 <br /> a $trw 2u <br /> Street city Unit 4 <br /> a streai a <br /> e sveet a Q Unit 5 <br /> 40 street <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> ,dE UNDERGROUND TANK{UST)CLEANUP SITE(LOP) LI HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> I OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ' tE�UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> © HAZARDOUS WASTE GENERATOR © CHICKEN RANCH E3 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY CO MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> Q TATTOOIBODY PIERCING E3 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ra OTHER(PLEASE SPECIFY) <br /> ' 1 List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es) At least one fie type MUST be selected Fax to(2091464-0138 or snail to the <br /> address indicated above <br /> ' 2 EHD will notify the applicant If any EHD files exist. An appointment for review wdl 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 EHp 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 /> 6 "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 I TIME <br /> DATE CONFIRMED— PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW HATE <br /> CHR 48-42.006 <br /> \�.� <br /> 618120A3 -*y�� <br /> 1► 1Tti�"L ,� t �1 v V A` <br /> f <br />