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EHn LOC Ntlr/grR <br /> �,,� 1� j SAN JOA.QUIN COUNTY <br /> ENVIRONMENTALHEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> APP 2 E 2006(209) 468-3420 Fax: (209) 464-01.38 Web: ww-,v.co.san-joaqu:jri.ca.Lis/ehd <br /> ENVIROWNIENI' I-iEALTN FU-BLIC RECORDS RELEASE APPLICATION <br /> PFRMITISERMUS <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE: y(p-7'3�7fl FACSIMILE;. �' 2z <br /> TENTATIVE*APPOINTMENT DATE: Rau ( co(-riJ- _Time. <br /> (Please allow 10 business days from date of appl9catlon submittat) <br /> + CHECK BOX TO F_XPEDITE R$G2UEST-$93.Sfl FEc-REQUEST PROCESSED iN 3 6USiNcS.S GAYS <br /> SIGNATURE OF APPLICANT p 01E L <br /> Department Vse Only <br /> F14E ADDRES$ UNIT <br /> t, street N ,,' A cn� dEl <br /> Clty ��i~ <br /> o� i aid,. cny ciy CCK '�i�`� <br /> 3. Street t „ 57 <br /> Gr ^rte n�= — <br /> a. stye^t <br /> an 01 `T. Mr-1Cn <br /> Cl <br /> 1U. Strear <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> II/t)NDERGROUND TANK(115'r)CLF_ANUP SITE E(LOP) O HOUSING"ATEMENT ❑ SOLID WASTE FACILITY <br /> d OTHER CI_) ANUP SITE(NON-LOP) ❑ FOOD FACILITY d SOLID WASTE VEHICLE <br /> G3�//UNI]ERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 6 NDFRDUUS WASTE GENERATOR C1 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> C�7 T1EF:ED PERMITTED FACILITY IJMOTELIHOTEL ❑ PUMPER TRUCKrYAPPICHEM TOILETS <br /> ❑ TArT00(BODY PIERCING D POOUSPA O LAND USE APP <br /> IiCATiON 51'rES <br /> ❑ MEDICAL WASTE FACILITY ❑ OIHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the listaboye by checking <br /> the appropriate bOX(es). At least one file type MUST be selected. Fax to fj0J 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. Anew <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 EHO 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 TiMI; <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHP 4F-Q2-00� <br /> nrnnoaa <br />