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DATE RECEIVED <br /> EHD LOG NUMBER <br /> ��,�, ED) SAN JOAQUW CO ENVIRONMENTAL HEALTH EPAIiTMENT. <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> 2007 Telephone:(209)468--3420 Fax: (209)464-0138 Web:WWW.sjgov.org/eh <br /> EtiV'R��Ir�cP�1' H EALIR <br /> Yr t , PUBLIC RECORDS RELEAS APPLICATION <br /> APPLICANT: Scor LASE-( <br /> ... ,..,._... .. ,_ USINESSlAGENCY; •eOLy}t <br /> ADDRESS: -P-b al S I-'LA-Fq e� STI' Ew-T ZS L'tE 3> 1A <br /> PHONE(1):6 'o ho PHONE(2): (0S(-_7(0&-'73d9_ Cid( FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application subm 1-'Tentative only-must be confirmed) <br /> El CHECK BOX TO ExPEDITE RE T-$95.00 EE OR ECK NLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Q List❑Map---Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ff Unit 1 <br /> 2• ^ .�C9 P-0 D l9 ❑ Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 6• <br /> 7. <br /> 8. ❑ Unit s <br /> 9. <br /> I)- ❑ Unitli <br /> Specific Date Range of Information Requested:From P--jal A6EP to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMESNT ❑SOLID WASTE FACILITYIVEHICLE <br /> CLEANUP SITE(NON-LOP) d FOOD FACILITY 13 WASTE TIRE <br /> UNDERGROUND TANK(MONJTORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PE wffT6D FACILITY 0 MaTsJHoTEL Q PUMPER TRUCKIYAROICHEM TOILETS <br /> 0 TATTOWBODY PIERCING 0 POWSPA 13 LAND USE APPLICATION SMS <br /> O MEDICAL WASTE FACILITY E3 OTHER(PL.EtASE SPECI <br /> WEi i AND 51=P7lC PERMIT fZECOROS ARE AVA1lA8L.E FDR REVIEW- MONDAY-FRIDAY 8:110 Am-5:00pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the types)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to 20 464-013 or mail to the address indicated above, Address <br /> ranges will not be accepted-for additional assistance with file addre ses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist, An appointme t for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum f five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> 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 of the applicant <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> I EHD USE ONLY <br /> EHD 4806 911414:706 <br />