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GATE RECCIV60EHD LUG NUMBER <br /> SAN JOAQUIN COUNTY • <br /> L-J) ENVIRONMENTAL HEALTIJ DEPARTMENT <br /> 304 E Weber Ave 3"1 Floor Stockton, CA 95205 <br /> If : $ 7005 (209) 468-3420 Fax; (209)464-0138 Web: www.co.san joaquin.ca.us/eI.d RO <br /> ENViR-lj R��,Ei�i1 HEATH PUBLIC RECORDS RELEASE APPLICATION <br /> PE *s*�1 } � <br /> APPLICANT://�� �)�",!t,C'—Ld, n 1 r� BUSINESSIAGENCY:�L� <br /> ADDRESS: "T D 2 1 y\d.Us4-i e CyA)A,, , Ly-cr,-;1 R S-1-4 Q <br /> PHONE: 31��"3 T� t T"FACSIMILE: 3 (49I - <br /> TENTATIVE"APPOINTMENT DATE: I'D f z(R 140 S Timo: `� ' (71-0(Please allow 10 business days from date of application submittal) CD <br /> © CHECK BOX TO EXPEDITE REQUEST-$53.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE of APPLICANT HATE /D 1 C)� cc <br /> D002"ment Use <br /> FILE ADDRESS UNIT <br /> street S 153 v� s 4 a. S , <br /> 2. GUeet e. M •v\ S o ❑ Unit 11 <br /> 4. S4eN l 15ZSD - ll� - plv Ste. I3 Unit 2 <br /> s. Slrtt 40-15--E- - M AAK e}. all •��-iz�c.a-, a(,o <br /> e. street <br /> /ll. �aivVr�RCY f� v 4 - as 94-a Jt Unita 1 <br /> sl cl at Unit 4 <br /> e. sI eM r <br /> CityEl Unit 5 <br /> f0. Street CI <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> )0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) © HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-IAP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDTCHEM TOILETS <br /> ❑ TATTOOISODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)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 /> CONFIRMED APPOINTMENT PATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 40.02-000 <br /> oronaoa <br />