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JAN JUAQU1N I_OUN1Y <br /> EIRRONMENTAL 11EALT11 DEPAR*ENT <br /> E Weber Ave 3d Floor Stockton, CA 9 205 <br /> APR 15 z09)468-3420 Fax: (209) 464-0138 Web:www.co.san-joaquin.ca.US/ehd1 7 <br /> i �NLTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ltP✓�L C//�ct-✓- —BUSINESS/AGENCY: <br /> �� 77Y`�(,("7�1�5 GWIII ✓'WfVGLP X _L�i�, <br /> ADDRESS:_Z.�. / ( wi 8c^OYI 26t,✓ I L ) i Y-eI S G-yfC 5, P.G`m 6 ,�, 4 C( S-6 "t2__ <br /> PHONE: Sao-G 6–�GG� FACSIMILE: Y30 -67-6 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittaQ <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEES–�ES�T>PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 7fL �/. ( /u(�� DATE <br /> i <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> �. so-« - — ❑ Unit 1 <br /> .satt. .� �a 1 5 , /YJ <br /> L2. 1_50 <br /> .L �� <br /> I U � 5/r�C,�rn oZ� Un4 2 <br /> 4. s 91 f ✓vt e Shred fae ink.. <br /> 5. Sew/6. v3 �/ S / Unit 3 3 <br /> r. X10 E , /b1iv1E� iii. CRY Unit4 <br /> CIA <br /> 9. Se _ b r \ S�- <br /> I31 ❑ Unit 5 <br /> 10. sew <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 77 ' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13SOLID WASTE FACT <br /> OTHER CLEANUP SITE(NON{Op) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 'UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATYOOIBOOY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FAcILrTY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the typ (s)of files from the list aboye 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. 1 <br /> 6. Applications received after 3:00 pm will be processed the next business dam) ki _Fri < <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONE <br /> FAX- INITIALS <br /> REVIEWED ` YES NO REVIEW DATE <br /> EH 4ELSL06 <br /> ererzaoi <br />