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DATE RECEIVED EHD LOG NUMBER <br /> i D}{ •,� c' i /7 ,1_` SAN JOAQUIN COUNTY <br /> �E[D, IRONYIENTAL HEALTH DEPAR4ENT <br /> SEP 12 20304 E Weber Ave P Floor Stockton, CA 95205 <br /> 9)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ,7.,wikUNMENT HEALTH <br /> nFRMIT/SERVICES PUBLIC RECORDS RELEASE APPLICrATI�O/N <br /> APPLICANT: O 0 BUS•IN�ESSIAGENCY: <br /> ADDRESSde e /'%.c. G( �✓e' s �T L�L n0-530 <br /> PHONE: Z to g Z 3`� U l`i$ FACSIMILE: Z0 q Z 3�[ <br /> jt-"3 <br /> TENTATIVE*APPOINTMENT DATE: �/ SGDT O Time: <br /> (Please allow TQ business.days'06M dateof application submittal) <br /> CHECK BOX TO EXPEDITE AE 2UEST- 3 Oo FEE-REQUEST.PROCS�SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICDATE'<.i <br /> DeparlmenE Use Only <br /> 4w11 D...A:.. <br /> _ DRESS : - ....... .J. ._ : . ^. .UNIT <br /> t. .steel 7.5 Cma C:( S a <br /> . .. _.-_ __ _._.__ 0 Unit T. <br /> Ity <br /> 3 steel 2 ..a .:. . nit 2 <br /> 4. Stroet " aty <br /> S. swed1 <br /> :.. <br /> 6. steZ. p __... .. 3 <br /> el <br /> �. swe Sa6 Unit4 <br /> e. strca ?-45 <br /> a. sleet a Unit 5 <br /> 10. skeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES RVA,"-.1 <br /> ❑: NDERGROUND TANK(UST)CLEANUP SITE(LOP):O HOUSING ABATEMENT O SOLIDWASTE FACILITY e, <br /> i�THER CLEANUP SITE(NON4.OPI-- "' O FOOD FACILITY­"` a_ `13 SOLID'WASTE VEHICLE" <br /> UNDERGROUND TANK(MONITORING/REMOVAL) <br /> O DOG KENNEL A DAIRY. <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING O POOLISPA Cl LAND USE APPLICATION SITES , <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE.SPECI.FP <br /> 1. List up to ten addresses in the space above..Select the type(s)sof files the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(208)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.daiys for review: Appoinxments.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"keleaisiii will be reorgatt sd by_f�iD staff at the expense <br /> of the applicant..,Future file.revjews by the game,applicant may requI ji,a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed•with EHD staff <br /> 6. Applications received after 3:00 pm will be processed the next busind6ii'daryRu. <br /> CONFIRMED APPOINTMENT DATE TI'M <br /> DATE CONFIRMED PHONE FAX. . INITIALS <br /> REVIEWED YES NO REVIEW.DATE; <br /> 003 fil '" rrylib <br /> Mk . T FLia e /11Dcol'$ P� <br />