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ATERECEIVED �. EHD LOG NUMBER / <br /> � -�c �i1Q7 " SAN JOAQUIN COUNTY <br /> PIE" <br /> IC<<:.� I!`.'_�/�. ��} ERONMENTAL HEALTH DEPAR y <br /> SEP 1 2 2 304 E Weber Ave Yd Floor Stockton, CA 45205N ' <br /> M 468-3420 Fax: (209)4640138 Web: www.co.san-joaquin.ca.uslehd <br /> '=igVIRUNMENT HEALTH <br /> PCRMIT/SERACES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t L Q OK BUSINESSJAGENCY: C Or E� <br /> ADDRESS:1�i'n_ �'Y.c-.t Lc 1✓e' S T C�., T�� <br /> PHONE: FACSIMILE:_ZO 9 L 3 4 0-530 <br /> t.CQ'3 <br /> TENTATIVE'APPOINTMENT DATE: Lt/,e el r & Time.. <br /> (Please allow 14 business d*tr6&4& of application submittal} <br /> CHECK BOX TO EXPEDITE.REQUEST- 300 FEE_—REQUEST-PgOC ED.IN}3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT : (✓r> : c:�, : r,.:..DATE:ii f <br /> ., Department Use Ordy <br /> Flu CRESS _...:. <br /> a <br /> a t <br /> " is <br /> ... t)NtT <br /> t. .stns ( a <br /> -+� ' `' :.❑ . .unit�:_ <br /> a: steal Z,7 0.. ...._E CRY <br /> e. Steal G ❑ Unit <br /> s. Steel 0 (� <br /> �j <br /> 3 <br /> 6. Street L L:r: :.t ,- a <br /> at <br /> 7. sw <br /> a sit Z Unit 4 <br /> °' ,. Uttlt 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> C�,UNDERtiROUND LANK(UST)CLEANUP SITE(LOts):.Q HOUSING ABATEJVIENT D SOLIb.YPA$7E FACILITY 1 :j <br /> ii�� 11M CI:FJ►MUP S11E(NO 4LOPy--. O FOOD FACflMr,.. _ p SOLID WASTE 1/ HICt1: . <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL.! d DAIRY .! <br /> ❑ HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH_ 'O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 13 MOTELiHOTEL O PUMPER TRUCr4YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING O POOLISPA D LAND USE APPUCA71ON SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASE.SPECIM <br /> 1. List up to ten addresses in the space above. Select the type(s)�of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address indicated above. :r <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later:than ten(10)days after receipt of apolicstlon .The files <br /> will be held for a maximum of.five business,daxs:for.review.' AppolnUnents.should be.scheduled <br /> accordingly. ` <br /> 3. A file that is actively beingworked on by EHD-staff iriay not bs riiihi ' ely available for review. A new <br /> application may be submitted when the file is available. r r <br /> 4. Any file not returned.in'thesame condition tl;;ie116,#6!will be reorgati) ed tiy`EHD$teff at ttl+a expense <br /> of the appilcant ,-Future filo,revlews by the s{ ti�e;appilcant may require a: 93.49 depositprior 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 nextbus)nessAU,;d�ty USH <br /> CONFIRMED APPOINTMENT DATE TIM0 -__ <br /> DATE CONFIRMED PHONE ;< FAX '1NlTIAL.S <br /> REVIEWED YES NOREVIEW.DAT . , <br /> EMID <br /> 240 � : m� t I n ftt r'n q ► s, s .for .7t,G, '1 <br />