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-�tt,t IVtU EHD LOG NUMBER C y <br /> SAN JOAQUIN COUNTY <br /> ]ENVIRONMENTAL VIRONMENZ'AL HEALTH DEPARTMENT <br /> 304 E Weber.Ave 3`'Floot Stockton, CA 95205 <br /> (�209) 468-3420 Fac: (209) 464-0138 Web: www.co.san;joaquin.ca.uS/ehd <br /> r-111IIn4A,',uNa ILAITH PUBLIC RECORDS )RELEASE APPLICATION <br /> BUSINESSIAGENCY: <br /> ADDRESS: O Z �.h coyCV �l(�.Q W c l,Cj y� `7� iL✓� <br /> PHONE: J FACSIMILE: (9.!� <br /> TENTATIVE"APPOINTMENT DATE: _54 (co-M (A -Time: ^R_ <br /> (Flease allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE-BEQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE _3�_Z4()Lp _ <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. stre°t SI o 3 -�. _271 k1. Unit <br /> 2. Slrqel 0 Unit 1 <br /> .�^ <br /> s. sure, t 2c1 N P-A. 0• ` City <br /> r#� �? <br /> A. Street L"", G V <br /> Q Unit 2 <br /> 5. Street 9 1 o'a 1y. 4r, cit, <br /> S•. r,C�. - �-- <br /> 6. 3trect � (� ��• Q ,.kms,` �y [".. � <br /> Unit 3 <br /> ?. sired d 1`I• S . 2�. °1°I _ city. Unit <br /> B. StreM �v v /�.�'yt]�_� I Gt�� !A`� ,�. A�•'`t'` � <br /> 10, Street Unit 5 <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLID WASTE FAC1L,rFY <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> �I TIERED PERMrrTED FACILITY C� MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> Q TATTOO/BODY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY 13 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 DATE TIME <br /> DATE CONFIRMED ___.. PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD 44-02.Qg4 <br /> era�zoaa <br />