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LUUi L . 00 rAd LUL N4tlUULI 001 <br /> DATE RECEIVED <br /> A <br /> r _ SAN JOAQUA`i COUNTY V wv V <br /> F _RONIYIENTAL HEALTH DEYA.RTN� AT <br /> AUG 304 E Weber Ave 3rd Floor Stockton, CA 95205 0 4 ) 468-3420 Fax: (209) 464-0138 Web.' www.co.smjoaquin,mudiald <br /> N�FIRONMENi HEALTH PUBLIC RECORDS RELEASE A.PPLICATUON <br /> qqo <br /> APPLICANT: USINESS! ENCY: <br /> ADOI <br /> N PHONE: ` 7 — ` 7�` fFACSIMILE; (� <br /> TENTATIVE* APPOINTMENT DATE. <br /> � YLl/Qyclfa /� �� <br /> ` 1 (Please allow 10 bmInI days from date of application submittall �. <br /> CHECK BOX TO EXPEDITE REQUEST - $93.00 FE EQUEST P ESSEO IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � � DATE 7 <br /> ^'v <br /> Department Use Only <br /> FILE DRESS UNIT <br /> �a 1. So- <br /> z. spa ❑ Unit 1 <br /> G ^� <br /> 1. Sheet 09 ❑ tlnit 2 �, V <br /> 5. Sleet [ <br /> s s�. ❑ Unita <br /> r. 5acc G <br /> W a• sae, 422920 G P S <br /> ti s. sues ❑ Unit 5 <br /> � 10. 5ueel <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SUE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> v OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> V ❑ UNOERGROUND TANK (MONITORINGIREMOVAL) LI DOG KrNNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILfTY ❑ MOTELIHOTEL ❑ PUMPERTRUCWYARDICHEM TOILETS <br /> ❑ TATTOOI60DY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTF 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) 46470133 or mail to the <br /> address lndto ed above <br /> 2. END 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 /> ON FIR <br /> M.F7rD- APPO1NTM ENT DATE. ' <br /> , .: .. TIME <br /> I)ATF 'CONFIRMECI "PHONE . FAX ' ' : ." )i NITJAIS ' <br /> REVIEWED YES NO REVIEW DATE ' <br /> • �o u-0z.�as <br /> uerzooa <br />