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ATE RECEIVED i , EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ECOVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3 Floor Stockton,CA 95205 <br /> AUG 13 20W9)468-3420 Fax: (209)464-0138 Web: Vi_ww.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KikAw NfrC,ACAJV BUSINESS/AGENCY: �?icA'7VS etgyilCONMENIAL, Twc. <br /> ADDRESS: ;330 GAMC-korJ ?4R.IC bf., 4FS50 t;y111 Buri ?&Q,IC CA %6S2- <br /> PHONE: JF'3 0 61',& 600-4 FACSIMILE: 530 616 60 05 <br /> TENTATIVE*APPOINTMENT DATE: I3 y' Time: 03;00 h^d <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$ FEE—( QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT VOW <br /> .K DATE Dd 3 IO <br /> Department Use Only <br /> FILE ADDRESS •'UNIT <br /> 1 V2 i. street 2 ZS' GOVNIL4 C W b LAt4e city $TOCATOrV MT , (o <br /> f�(♦Z 4-.V _---u a .1 �-- s E] Unit 1 <br /> 3. sweat 2 f Z_ „ a a v2, - 1 �) t{ <br /> f NZ Unit 2 <br /> 4. s&w SOS ._-- -- a it ❑ 3 � <br /> ' s. strca aty Unit 3 <br /> e. street City <br /> 7. street aty <br /> d. 3"d CAY <br /> 9. svw oty <br /> ❑ Unit <br /> 110. street aty <br /> y ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types)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. <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 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 now. <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 /> 6. Applications received after 3:00 pm will be processed the next business day. RUS 14 <br /> COTIFIRMED,061NTMENT DATE TIME F: <br /> PATE CONFIRMED PHONE - FAX' INITIALS` <br /> REVIEWED YES NO REVIEW DATE <br /> . tares 4f9i - <br /> tvers9o3 <br />