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DATE RECEIVED SAN JOAQUIN COUNTY <br /> ! '.;'! `)l EJ% Ik�NMENTAL HEALTH DEPARTMI _T <br /> ` 304 E Weber Ave P Floor Stockton, CA 95205 <br /> AUG 0 3(209�468-3420 Fax.: (209)464-0138 Web:www.co.s2n-joaquin.ca.u&/ehd <br /> lq?6 <br /> ENV1R0N1,1EN1 HEALFH PUBLIC RECORDS RELEASE APPLICATION <br /> r <br /> M /7" StAEV A <br /> j APPLICANT: d S BUSiN£SSIAGENCY: <br /> � ADDRESS: ' <br /> MP Y <br /> i � <br /> PHONE: r I FACSIMILE: ~ 2- q <br /> y <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> 1 (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE; REQUEST 9 .00 FEE QUEST PROCESSED IN 3 BUSINESS DAYS <br /> '� DATE <br /> SIGNATURE OF APPLICANT <br /> Department Use Only <br /> F p. FILE ADDRESS UNIT <br /> P2. SteM <br /> 40 . D ❑ Unit 1 <br /> city Un �1%v <br /> 4. Street City <br /> p G r <br /> S. sweet Unit 3 <br /> 6. Street Oty <br /> 7. Street t City 00 Unit 4 <br /> 8. Street I <br /> 9. Street G toe Unit 5 <br /> ty,0. Street d <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ��1 <br /> Cf UNDERGROUND TANK(UST)CLEANUP SITE(LAP) 0 HOUSING ABATEMENT E'SOLID WASTE FACILITY <br /> OTHER CLEANUP 517E(MON-LOP) <br /> ❑ FOOD FACILITY C7 SOLID WASTE VEHICLE <br /> Cf UNDERGROUND TANK(MONTTORIN(;IREMOVAL) E3 DOG KENNEL e DAIRY <br />+ Cy HAZARDOUS WASTE GENERATOR E!r CHICKEN RANCH ET PKG TREATMENT PLANT <br /> C/TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> [] TATTOOlBODY PIERCING <br /> ❑ POOLISPA CY LAND USE APPLICATION SITES <br /> Cr 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 aboye 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 /> 12. 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 flies <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. 11 <br /> :3. Afile 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 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 rappointment 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 :I 'PHONE FAX INlTlAIrS <br /> REVIEWED yYES NO REVIEW DATE' <br /> EHD 46-02-006 ;I <br /> 8!8!2003 <br /> i <br /> i� <br />