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03/23/2006 14:21 FAX • ¢j002/002 <br /> env wo..u. <br /> GATE REGEI'JEQ SA,-4 1tpAQL-INI CO'C71(TY <br /> ENVIRONMENTAL HEALTH T)F,PARTMENT <br /> 304 E Weber Ave 3`d floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 NVeb:www.co.san joaquia.cWR 23 PM 2 23 <br /> PUSLICRECORDS RELEASE APPLICATION,; ;c ou;n. c-T4: <br /> :.. 0 tY § 17Y UYe r1ENT IAL, <br /> G-)gyp ��.-7�FC A�nufip USiNESWAGENCY: tNf t ` HDEPP,RTPiENT <br /> ! <br /> ADDRESS:�,. , ^ <br /> (L� ` F- - <br /> PHONE: <br /> PHONE: S? 1 l 13�J FACSIMILE:_.5 �f I n z . <br /> TENTATIVE'APPOINTMENT DATE' Tune: - <br /> (Please allow 10 business days"m date of application submit•.al) <br /> CHECK BOX TO EXPEDITE REQUEST•$anas FEE-REQUEST PROCESSED IN ]BUSINVSS DAYS <br /> SIGNATURE OF APPLICANT _ _ DATE <br /> Department Uso On* <br /> UNIT <br /> FILE ADDRESS <br /> Z-3 C. q Dr:✓ G S r« jUn <br /> y sv n G (4r I�! U rq C1 p ` <br /> a. sv�e `( t-•�r� C.. a� (ti t F Unitj <br /> �..' (_.(.ter` ✓ an �rS >5• t. 1-. e) E. GHr <br /> V 1n. Sten �d �.:5 �• Gfi �" <br /> N �rt Fri >7 D. "2��pJ �t 4,•'C S�S'{kMs\ EVIRONMENTAi.HEALTH DEPARTMENT FILES <br /> tA UNDERGROJND YANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 12L soi.ID WASTE FACILrY <br /> 6 OTHER CLEANUP SITE LHON LOP) ❑ FOOD FACILrrY ❑ SOLID WASTE VF141CLE <br /> 9� UNDERGROUND TANK(MONITORTNGIREMOVAL) ❑ DOG KENNEL E-DAIRY ' <br /> Z HAZARDOUS WASTE GENERATOR Cl CHICKEN R,>NCH 4'T..PKG TREATMENT PIJJ4T <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL 0 PUMPER TRucwwstDICl-tEM TOILETS <br /> ❑ TATTOOISODY PIERCING O POOLtSPA LAND USE APPLICATION SrMS <br /> ❑ MEDICAL.WASTE FACILITY ❑ OTHER(PLEASE SPECIf'r)_ ________ ..._�—�.--•—'^"- <br /> 1. List up to ten addresses in the space above. Select the types) of riles from the list above by checking <br /> the appropriate box(es). At least one rile type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant it any EHD riles 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 alpaximum of rive 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. Anew <br /> application may be submitted when the file is available. <br /> 4_ Any file not returned in the some condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future rile reviews by the same applicant may require a $93.00 deposit prior to review. <br /> $, 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications received after 3100 pm will be processed the next business day. — <br /> .CaNFIR1ND`ipolNrrriENTdaTs TIME <br /> ^ � <br /> (, .. IWTIALS <br /> ,'DATE CgNF1R9ED PHONE FARC' <br /> NO <br /> FE`r'IEWEC7 YES _ <br />