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EHDLUCiNLJMt5LK I� <br /> DATE RECEIVED ,. SAN JOAQUIN COUNTY 4 <br /> nJ E f J ENVI1Ec'TINMENTAL HEALTH DEPART <br /> MAR 17 304 E Weber Ave 31d Floor Stockton, CA 95205 <br /> 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> 73 <br /> ENV1R0Ni'vbV'i HEALTH <br /> PER nvI �ISERV CAL PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: T $ BUSINESSIAGENCY: <br /> ADDRESS: V <br /> PHONE: CSIMILE• <br /> 7,o 9, f ls'104ENTAT1`VE'APPOINTMENT DATE: Time: <br /> err (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93 00 FEE—REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> „ a <br /> Department Use Only <br /> FILE ADDRESS <br /> ,. shed u a v TvUnit 1 <br /> 2. sheet Q f)V 1 N 1'1 A R r . <br /> 3. sheet 3-! o a ❑ Unit.2 <br /> 4. Street a ! Y <br /> F3 s a Unit 3 <br /> 6. Sheet <br /> et G Uri <br /> 7. she <br /> 8. Shed <br /> s, sheet a Unit 5 <br /> CdV <br /> 10. shed <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> SO UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3HOUSING ABATEMENT d SOLID WASTE, C1LL a. ' <br /> FOOD FACILITY CISOLID WAS > _' <br /> W OTHER CLEANUP SITE(NON-LOP) <br /> ® RI <br /> UNDERGROUND TANK(MONITONGIREMOVAL) ❑ DOG KENNlrL C3 DAIRY <br /> J1 PLHAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH C3DAIDAI ANT <br /> p PUMPERTREATMENT NT PL DICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL <br /> TATTOOIBODY PIERCING 13POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL.WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> �. List up to ten addresses in the space above. Select the type(s)of fifes from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 454-0138 or mail to the <br /> addressindicated above. <br /> 2. EHD will notify the applicant if any EHD files exisL 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. Anew <br /> application may be submitted when the file Is available. <br /> 4. Any fileinot 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 /> 9 9M <br /> CONFIRMED APP61NTMENTUATE <br /> TIMEA' <br /> HATE CONFIRMED. -PHONE FAX' aNfTIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EfiO48-02-0as ., . <br /> I ttranoo3 - ' <br />