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j. <br /> � DATE-RECEIVED :; •, ,,• ., , <br /> SAN JOAQUIN COUNTY <br /> f ENVIRONMENTAL HEALTH]DEPARTMENT ` <br /> 304 E Weber Ave 3'Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0135 Web:WWW.co.san joaquin.ca.us/ehd <br /> f <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �IFg' � BUSINESS/AGENCY: 04L-4 S C-1L11C- 1�—C AJ6--- <br /> ADDRESS: �Sc7 ��J�'-jam. J +4 GGSG+til C,4 <br /> (Q LF Z <br /> PHONE 2 2-3- J fit{( FACSIMILE: <br /> f <br /> TENTATIVE*APPOINTMENT DATE:. �� _Time: 9- .',3c) <br /> (Please allow 10 business days from date of application <br /> submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST93.00 - ST SE N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT f� <br /> DATE -2 <br /> E Partment se only <br /> FILE ADDRESS UNIT <br /> a 1c � <br /> v <br /> i. Street ❑ Unit 1 <br /> 3. Street � ; <br /> 4. Suet Unit 2 ; <br /> 5. Sheet d <br /> s. sweet ❑ Unit 3 <br /> i. Streei <br /> e- sheet is ❑ Unit 4 <br /> 9. Street <br /> Ci <br /> to. street ❑ Unit 5 <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 4 �tt� <br /> ❑ UND <br /> ERGROUND TANK(UST)CLEANUP SITE LOP ❑ <br /> ❑ OTHER CLEANUP SrTE NON-LOP ( ❑ HOUSING ABATEMENT ❑ SOLID WAS <br /> ( ) FOOD FACILITY ❑ SOLID WASTE VEHICLE ( i <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 17 TATTOOIBODY PIERCING ❑ POOLISPA LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ 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 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 /> CONFIRME© i4PPOIN'tMENT DATE TIME <br /> OATS CONFIRMED 4 NONE .''< FAX lNITIAI.S <br /> R1=Y�FWi~D { � <br /> YES :NO REVIEW DATE. <br /> E812003 2 EW6 ?-90 0 : R C y � y/J <br /> tN8l2043 f-�_! <br />