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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTI3 DEPARTMENT <br /> SEF 2 9 304 E Weber Ave 3`d Floor Stockton. CA 95205 <br /> 019)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquiti.ca.us/ehd <br /> L VIP, , L c ,r ES PUBLIC RECORDS RELEASE APPLICAU ON <br /> APPLICANT: �O�rl \--Cr e— BUSINEss/AGENCY:_610Vnc^ Z0-,0 ANC,\\/,5;-s <br /> ADDRESS- n`N Mc,�A 5}. Escglan. CA 95--32-C> <br /> PHONE:_(7, 0�) S ?,S —CA FVY —FACSIMILE: F—'q O p 6 p <br /> 3 <br /> TENTATIVE`APPOINTMENT DATE: Q� Tlmc: W1 <br /> (Please allow 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST•$93. FEE— EQUEST PROCESSED IN 3 BUSINESS DAYS II <br /> SIGNATURE OF APPLICANT DATE tT� <br /> Department Use Ont/ <br /> FILE ADDRESS UNIT <br /> ,. str_t S C s 3 55 7 D q <br /> z. sh"i -0 T . I G Unit 1 <br /> 3. Strom <br /> ❑ Unit 2 <br /> s"e <br /> fi. Svgq� Gl <br /> Unit 3 <br /> 7. sb—A ` �UNR4 <br /> a sem+ <br /> C12 Unit 5 <br /> ro. saeac <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> �s1 OTHER cLEANUP SITE(NON.LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> JI HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 1ffi TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOBODY PIERCING El POOLJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to tan addresses in the space above. Select the type(s)of files from the fist above 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 tiles <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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> "v 48-u- e <br /> dermas <br /> Td Wd60:170 beet 6Z 'daS 2886 828 60E : 'ON 3NOHd sTsFjPLd oaaz punoa0 : WOyd <br />