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LiMt c <br /> SAN JOAQUIN COUNTY <br /> EMD LOG NUMBER <br /> `+NVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave P Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web. w .co.san joaquin.ca.us/eb.d <br /> �iAO\ vw: <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ppFFRR��������c,� E Q A <br /> APi't1CAN'P: C? C fi0 BUSiNESStAGENCY: <br /> ADDRESS: <br /> PHONE: J(p - _FACSIMILE: 9 � <br /> TENTATIVE"APPOINTMENT DATE: 5/ ((R./d CD _ -Time: 6-D <br /> (Please ailow 10 business days from date of appilcation submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.40 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE _ U Lp <br /> Department Use Only <br /> FiLE ADDRESS UNIT <br /> P . k)''. a �y <br /> 2. stnset 2 W• r Gt �/' ; ` '" ❑ Unit 1 <br /> 3. StrohIV, �_. ITM°' <br /> 4. Sreei �N ❑ Untt 2 <br /> s, Vreet O'1?-(y Unit 3 <br /> 6, 81ract l� . P�/-�• p b d •(Yti /�a <br /> 7. Sheet d I`�r . 1• S Z-k. )-l <br /> s. sr�t <br /> -� b C•N Unit 4 <br /> 9. SIree 1v v .c) . 1 Pty <br /> ❑ Unit 5 <br /> 10, street G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FAC1LWY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORiNGiREMOVAL) 0 DOG KENNEL Cl DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMnTED FACILITY Cl MOTEL1HOTEL ❑ PUMPER TRUCKiYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($) of fifes from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0130 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 /> CONFIRMF-D APPOINTMENT DATE TiME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REViEW DATE <br /> UHD 4a-02�000 <br /> &%%..003 <br />