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EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> EU-1 g ZQo 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> <V?( "S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,N1� �},G� BUSINESS/AGENCY: <br /> A-UJ'Z Cuvil�N�!'rU1 tu! Cill��/ <br /> ADDRESS: <br /> i42S V21VeV 11)k1Z 1)IIt,� X2-6 Slrc- C/i -iins <br /> PHONE: <br /> '11L ci 2!-(J 6cC FACSIMILE: -tit (v-�Ur <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> �Jl�l�i DATE <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> ,. street 217!0 lvuc./A�rhuV UIIvr- a II-X0 E] Unit 1 <br /> CG <br /> 2. Street <br /> a ❑ Unit 2 <br /> 3. Street <br /> Ci <br /> 4. Street <br /> c; Unit 3 <br /> S. Street <br /> Q <br /> 6. Street <br /> c; nit 4 <br /> 7. Street <br /> Ci <br /> . Street Unit 5 <br /> Ci E:19. Street <br /> Ci <br /> 1o. Street <br /> 8t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> LQ OTHER CLEANUP SITE(NON-LOP) <br /> ❑ FOOD FACILITY 13SOLID WASTE VEHICLE <br /> r3 DOG KENNEL 13 DAIRY <br /> [*� UNDERGROUND TANK(MONITORING/REMOVAL) 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Cl( HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL E3 PUMPER TRUCK/YARD/CHEM TOILETS <br /> C3 TIERED PERMITTED FACILITY ❑ pOOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> &P MEDICAL WASTE FACILITY <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. 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 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 /> r <br /> ED APPOINTMENT DATE TIME <br /> FIRMEDPHONE _ FAX INITIALS <br /> YES NO REVIEW DATE <br /> EHD48-02406 <br /> 8!82061 <br />