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tHD LaG NUMtlER <br /> oATE RECEIVED SAN JOA,QU)IN COUNTY � <br /> ]ENVIRONMENTAL L AI.TH DEFAR'Z'19Z1,`I'T <br /> 304 F,Wober Ave 3`d Floor Stockton,CA 95205 <br /> (209)468-3420 Fix: (209)464-0138 Web: www.co.sanjoaquin.ca.us/cIA <br /> T'UB LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: u`� —BUSINF_SSIAGENGY: J-� <br /> ADDRESS <br /> PHONE= —7 1 FACSIMILE: a " <br /> n <br /> TENTATIVE*APPOINTMENT DATE: 83� Time: <br /> (Please allow 10 business stays from date of application submittal) <br /> GHI:GIC BOXTO EXPEDITER UE T-$93.00 REQU7=ST PROCESSED IN 3 BUSINESS DAYS ,� Y <br /> SIGNATURE OF APPLICANT - DATE e <br /> pep ent Use Only <br /> Mir IT <br /> FILE ADDRESS <br /> uG <br /> ,. atro�r I <br /> Z' street CAI <br /> s. strcot r: citi' ❑ Unit 2 <br /> 4. Street � <br /> s, strut Tj p' ( ` Unit 3 <br /> G <br /> Pr. Streot <br /> Unit 4 <br /> T. Street G1 i <br /> B. stress <br /> Gt <br /> Q Unit 5 <br /> 10. Strt:ci It . <br /> ENVIRONM)=N ATWENT FILES <br /> JWUNDERGROUND TANK(UST)CLEANUP SITE(LOP) [3OUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON•LOP) 0 FOOD FACILITY © SOLID WASTE VEHICLE <br /> tbk UNDERGROUND TANK(MONrrORING/REMOVAL) © DOG KENNEL © DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKC TREATMENT PLANT <br /> TIERED PERMITTED FACILITY . ❑ MOTEUHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> CK C] TIERED ERMIODY PIERCING D POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL.WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ton 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ <br /> ENp aa.az-0os • <br /> sm+•tana . <br />