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Nov 03 05 03: 14p Da w Murray 408-559-1224 p. l <br /> DATE RECEIVED <br /> ynVE�V ED SAN JOAQUJN COUNTY EHD LOG NUNMER <br /> ENVII20NMEN Ave3 HEALTH DEPARTMENT <br /> 95205 <br /> 'nn 304 E Weber ve 3r°Floor Stockton,CA 95205 <br /> NOV 3( 5468-3420 Fax: (209)464-0138 VSreb: www.co.san-joaquin.ca.us/ehd <br /> EWROWi W Heti'1TH U^B�}LIICC RECORDS RELEASE APPLICATION <br /> APPLICANT: I7/'1� VVnUKr�/1"�lNl BUSIINESS/AGENCY: �I� `✓1 VIr0/1�✓10N S'CYVICn C". <br /> ADDRESS: . IJ ,y�;. "0.SCOM AU•Q I P Sc�ylLrT0 s<-_ CA 9S-(;IZ .J <br /> PHONE: �CJ�/lS I D"l G-(o�{O�' FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST•$X�93.0pJF�jJJEE;�-R�EFJ�PaUES��T�PP,RO--,,CgqES��S/JEE��D IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ° V v Y//U(/V Irl 1 DATE —� <br /> -- Department Use Only <br /> FILE ADDRESS 1UNIT <br /> c. [I Unit 1 <br /> x steer S - F <br /> 3 anecr <br /> .. S:re t ❑ Unit 2 <br /> E. weer Ow aal Unit 3 <br /> E. neet <br /> sV <br /> - 7, sneer c Unit4 <br /> e. sb�t <br /> CAY <br /> 8. StreelCdy <br /> ❑ Unit 5 <br /> m. soem C!L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> /11l 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(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREA7INENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARD1CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA 13 LAND USE APPLICATION SITES <br /> ❑ 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(2091464-0138 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 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 /> 6. "TENTATIVE appointment dates must be confirmed with EHD 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 4842.06 <br /> LL3003 <br />