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Olt QJ/'LUob 11 :54 FAX 19002/002 <br /> ' �� LD)LGflai�w r.v...u�r, <br /> SAN JOA.QUIN COUNTY <br /> DNvIRONMENTAL HEA.LTjj DFPARTzyrENT <br /> c0po 3041~Weber Ave 3`a Floor Stockton, CA 95205 <br /> ENWR,iOi N:ib',j] 1-i4;Q? 468-3420 Fax: (209)464-01.38 Web:www-ca.san joaquia ca-us/ehd S5 <br /> �S . -<,� <br /> PEf��,III,,,L!��ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; ZYAN '5-ft 6 BUSINESSIAGENCY: <br /> PHONE: -LQj. !aqT- t34!j —FAC-SIMILE.'- 009 Qt$ O&RI <br /> TENTATIVE*APPowmiNT GATE: ! Z0 Tkne. <br /> (Please allow 10 businass days from date of application submittal) <br /> 171 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ^ _ DATE _ <br /> Deparb-nett Use Only <br /> FILE ADDRESS UNIT <br /> I. saea tlffl Elhadfi- Ge-l"F' aty <br /> 1, s,� o �� a >> F F. O Unit 1 <br /> 1tr" o Unit 2 <br /> .. Mr" e>r,d S� ti ...� <br /> s- Me" a 1 " F,f � Unit 3 <br /> Cky !'. <br /> oweo"Unit 4 <br /> 1. siredcky <br /> sre� <br /> L] Unit 5 <br /> �o- area ptv <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT &L SOLID WASTE FACILITY <br /> OTHER CLEANUP SrM(NON-LOP) ❑ FOOD FACILITY 10 SOLID WASTE VEHICLE <br /> ® UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL, 12�1-DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 8,PKG TREATMENT PLANT <br /> ❑ TIERED PERiN=D FACILfTY O MOTCLAHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOVSPA CL LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILnY ❑ OTHER(PLEASE SPECIFY) <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 46.4-01313 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 avallable 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 /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm wli(be processed the next'business day. <br /> CQNF,(RMFD ApRO1NTMENTT?ATE' -; " `e.�_ -1 <br /> X1Mtr <br /> DATE CONFIRMED - ?' PHONE FAX �- "INITIALS - <br /> REVIEWED YES NO REVIEW DATE ' <br /> ' �FI018-02-006 - <br />