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Nov 03 05 03: 14p Dawn Murray 408-559-1224 p. 1 <br /> DATE RECEIVED �� SAN JOAQUN COUNTY EHD LOG NUMBER <br /> WIECE <br /> ENviRoNMENTAL HEALTH DEPARTMENT <br /> 54 304 E Weber Ave 3rd Floor Stockton,CA 95205 3 <br /> N0� ' 3(- 6E-3420 Fax: (209)464-0138 VVeb: www.co.san-joaquin.ca.us/ehd <br /> ENIVIRON�ItEN� NEALI PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ` Prv �1 BUSIINESSIAGENCY: <br /> ADDRESS: � �/. �O.�S�OM /lu-e I" I Sc,.-L�To �p CA gSfP—p <br /> PHONE:_ {�i/15 1 6"l G—(aCG FACSIMILE: at'1 � / I-)_a q <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> ED CHECK BOX TO EXPEDITE REQUEST-$93.0 FEE—Ri*Q/U/E�ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT )Vgy(Y/V�i�/(/i/1'✓ t DATE +� <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. SFee1 CXR Ch• ❑ <br /> 2. SweUnit 1 <br /> et S , <br /> 3. Street - / <br /> F'1 Unit z <br /> 4. Street <br /> 6. Street CAY <br /> a. street Unit 3 <br /> 7. Street CRy <br /> Unit 4 <br /> e. S"et CAY <br /> e. steer cfty <br /> ❑ Unit 5 <br /> 10. street CRv <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for reviewwill 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 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 END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW'DATE <br /> EHD<8-02.006 <br /> 616/200] <br />