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06/06/2007 WED 15;36 FAX 2094189999 SJC PUBLIC WORKS X001/002 <br /> DATE RECEIVED <br /> -�V , SANTOAQUIN COUNTY <br /> OUNTEHb LOG NUMBER <br /> E MENTAL HEALTH DEPAR`f MENT <br /> 304 E Weber Ave 3 Floor Stockton,CA 95205 <br /> 12�698-3420 Fax: (209)464-Ot38 Web: www.co.san-joaqunca.us/e <br /> nr[� Ii 1i 9FN( HF4LVVBLIC RECORDS RELEASE APPLICATION <br /> APPLI&W"'lil5r � embez]Ing BUSINESS/AGENCY: San Joaquin County Public Works Department <br /> ADDRESS: 1810 E. Hazelton Avenue, Stockton, California 95205 <br /> PHONE: 953-7624 FACSIMILE: 468-2999 <br /> TENTATIVE"APPOINTMENT DATE: Timo: <br /> (Please allow 10 business days from dato of application submittal) <br /> r, <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS ` / <br /> SIGNATURE OF APPLICANT L7�� �'1R DATE !lam` <br /> Department Uto Only <br /> FILE ADDRESS UNIT <br /> o/�-- <br /> 2. swet q&o,7 orty ❑ Unit 1 •- <br /> a. 57rocf 41L 411 Cf L] Unit 2 <br /> / <br /> 4. 9heel <br /> s. sma '73S a Unit 3 X <br /> � <br /> e. srro� `f�07 Ca - L �s <br /> C. i Unit <br /> s. snv�t of <br /> fl sof S <br /> ctty ❑ Unit 5 <br /> �o, sve� PCS IKk17C�G �Y/�L° <br /> city <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT d SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONFTORING/REMOVAL) ❑ DOG KENNEL 11 DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL Q PUMPER TRUCKIYAROICHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOL/SPA ❑ LAND USE APPLICATION SrrFs <br /> ❑ 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 above by checking <br /> the appropriate box(es). At least one file type MUST be selected. F x 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 END 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 /> S. '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 /> VANE <br /> [T <br /> .......... <br /> �3(IEIl1( <br /> erro eoaz ooe _......_....:.. : :_..,.....,...._. <br /> sfwan r <br />