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ply..'` Environmental Group 91E 48`6688 P• 1 <br /> Oct 29 04 09: 58a . .. EHD LOG NUMBER <br /> ' <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> RW MENTAL HEALTH DEPARtMTNT Y , <br /> = 3 .Weber Ave 3rd Floor Stockton,CA 95205 1 <br /> 209 464-01.38.Web:www.ca.san-�aaqui�n.ca.uslehd <br /> -342 ax: (,_... ) <br /> .9 1100 <br /> -PUBLIC gECQRDS RELEASE APPLICATION i <br /> 1 Lr'+�.I t f stir - <br /> r SU5iNESSIAGENCY: <br /> LICAN �p F QA. Z b <br /> FACSIMILE: 1141 <br /> Time: <br /> TENTATIVE*APP0113TMENT DATE: <br /> O"'r submittal} <br /> Ir <br /> (Please allow 10 business days from date of application <br /> ;I <br /> U T PROCESSED II`3 BUSINESS DAYS <br /> ST <br /> CHECK BOX TO EXPEDITE REQUE -593.0o FEE— DATE f� Z O <br /> SIGNATURE OF APPLICANT I' Department USB Only <br /> UNIT <br /> IM FILE ADDRESS U <br /> r[3 <br /> Unit 1t� <br /> I, Street ` CI <br /> Unit <br /> 2. 51ree1 C; <br /> .k 2 J 1 <br /> ]. sveet , cvt <br /> e1C <br /> 4. Street og Gtv <br /> s. street <br /> 6. Street <br /> 1 ' Or11t <br /> g �. <br /> 7. street L .F <br /> CA <br /> B. Street ,F G <br /> 4. street <br /> C1 <br /> r'J }LZ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> 19 UNDERGROUND TANK{UST)CLEANIiP'S1TE(LOP) o FOOD FACILITY II SOLID WASTE VEHICLE <br /> W OTHER CLEANUP SITE(NON-LOP) 0 DOG KENNEL II DAIRY <br /> 1CJ UNDERGROUND TANK(MONITORINGIREMOVAL} t] CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 9 HAZARDOUS WASTE GENERATOR 0 MOTELIHOTEL II PUMPER TRUCKlYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY p pOOUSPA 13 LAND USE.APPLICATION SITES <br /> Q -TATTOO760DY PIERCING Cl OTHER(PLEASE SPECIFY} <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the type(s)of fifes from the list above by checking <br /> the appropriate box(es)..'[At least one file type MUST be selected. Fax to 209 464-4138 yr mai!to the <br /> onfirmed <br /> address in <br /> above. <br /> 2. EHD will notify the a'ppli;cant if any EHD files exist."An appointment for review will bllcatlon The files <br /> approximately five aX mem odays ve bust ess days for ter than, review Appointments shoo days after receipt Of pbe scheduled <br /> will be held for a m <br /> accordingly. ' <br /> 3, A file that is actively being worked on by EHD staff may not be immediately available for review: new <br /> application may be 'submitted when the file is available. at expense <br /> Panized by EHD 4. Any file not returned in the same condition <br /> ob ition as the same apple antwill <br /> bmaye reorE require a$93.00 deposit prior review.of the applicant- Future'file reviewsY <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 /> TIME <br /> CONFIRMED APPOINTMENT TATE INITIALS <br /> PHONE FAX ' . <br /> DATE CONFIRMED :9 <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> EHR 06.02.nOs <br /> 9!8200] <br /> i <br />