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OATE RECEIVED 0 SAN JOAQUIN COUNTY 0 <br /> EnU LOG tJUNOCn <br /> Ll INYIRONMENTAL HTALTn DEPARTMENT <br /> 304 B Webcr Ave 3rd floor Stockton, CA,95205(209) 468-3420 Fax: (209)464-0138 Web:www.cO.sanjoaquin.ca.us.1ehd Z 35TO <br /> PUBLIC RECORDS RUEASE APPLICATION ((// <br /> to ri�1n S A I 14 �Gti r c . <br /> APPLICANT: •� 1 n ',,� 1_ f�1 BUSINESSIAGENCY:n 14v <br /> ADDRESS:�D 4� Iv�Acn.�C•Tr�c'LJC �-•n A�-D lam_ fI <br /> PHONE:_ 31e-:- -'3-Tta I FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: ZZ Time: 1 ` <br /> (please allow 10 business days from date of apPlloation Submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93,00 FEE- EQUEST PROCESSED 1N 3 BUSINESS DAYS /�/O <br /> SIGNATURE OF APPLICANT DATE <br /> cp <br /> Department Use only <br /> FILE ADDRESS UNIT <br /> 5• a.w clr _S L� �5 l2 _ N T ❑ <br /> Unit 1 <br /> `- <br /> 2. Str ld <br /> 3. Rkm t Gf ❑ Unit 2 <br /> u: Unit 3 / <br /> r. seem ofUnif`4= <br /> B. Sircel C111, 4.• e <br /> a. snc c <br /> Oily Unit 5 ' <br /> 10, Street <br /> city <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FILES <br /> UNOERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL Cl DAIRY <br /> 'l7 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOTEVHOTEL 17 PUMPER TRUCKrYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOVSPA ❑ LAND USE APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above, Select the type(s) of fries 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 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 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 /> 3µ049A2-066 , <br /> aerzan3 <br />