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L, L_: , %' Ji OANdOAQUINUOUNTY <br /> ENTAL HEALTH DEPARTIIS <br /> APR 1 5 200 <br /> T0'4AhP1='r-Ave 3'd Floor Stockto <br /> Stockton,CA 95205 <br /> 209)468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca:uS/ehd <br /> Pr� did t L ;I�CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICMIT:_ kF1.-a9 L S. E45W HO 40o" BUSINESSIAGENCY. <br /> ADDRESS: :�o / =RoLt19 l.� y TRA Cy el* g 53 7 7 <br /> PHONE: L!6 D FACSIMILE: 'A o 4' P 3 o• 75-9-,0 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Pteus allow 10 business days from date of application submittaQ <br /> E3 CHECK BOX TO EXPEDITE REQUEST-"3.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE J4-1S_-"f <br /> Deva&nent Use Only <br /> FILE ADDRESS UNIT <br /> +• � I8 y.- CoVN ClvB. sTatkTaN RS�cy <br /> 2. SkW �lhtl�1 <br /> s. sk" <br /> .. VW o t)nit 2 - <br /> 'I aCRY <br /> 7. fted city <br /> city <br /> p unit s <br /> io. __Sired city <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> a UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> ■ OTHER CLEANUP SITE(NON-LOP) tit FOOD FACILITY O SOLID WASTE VEHICLE <br /> 9 UNDERGROUND TANK(M OVAL) O DOG KENNEL O DANtY <br /> W HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKO TREATMENT PLANT <br /> 9 TIERED PERMITTED FACILITY O MOTELMOTE. O PUMPER TRUCK/YARDKCIEM TOILETS <br /> O TATTOOMOD1f PIERCING .13 POOLISPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FAOILITY O OTHER(PLEASE SPECIF1t) <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(209146.40138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the aFgN nt if any EHD files exist. An appointment for review will be confumed <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 /> S. Applications received after 3:00 pm will be processed the next business day. <br /> 40NP �VIiDPINT�li1N�' AI f`::i :,� �>:3 :: >TIME <br /> *� F• r :_ <br /> ;DATA. NF1D _ � <br /> . RwlC. PHONE . x , <br /> .HO REVIEW DATE•tEV -YES ��''.•. <br /> .1 <br /> woos . <br />