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tHD LOU NUMMI", <br /> DATF RECEIVED SAN JOA.QUIN COUiVT`Y. y <br /> ENVIRONMENTAL HEALTH DEFARTMZNT <br /> 304 E Wober Ave 3`j Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.szn-joaquin.ra-us/ehd Z356 <br /> pUBLIC RECORDS RELEASE APPLICATION <br /> 1^ C <br /> l <br /> ApPLIGANT•. a"n t'S ��/�1 s"S U`� _BUSlNF.SSlAGENGY: �'�\ <br /> ADDRESS: q V �!V S`-Y r <br /> PHONE:_ ` � �. --L! /� FACSIMILE: '`� " <br /> TENTATIVE*APPOINTMENT DATE: 83 te <br /> (Please allow 10 business days from date of application submittal) <br /> XCHI=CK BOX TO]EXPEDITE R UE T-$93.00 F -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> Dep Ent Use OnlY <br /> • IT <br /> FILE ADDRESS <br /> ,. ssoct l Ci, uG <br /> FP ct I <br /> z, street V i t e <br /> at J ❑ Unit 2 <br /> r V c I <br /> 4. 5tree: � � <br /> 5, Street �� ql Un lt 3 <br /> 6. Street G ' <br /> r. Street Gt � Unit 4 <br /> city <br /> 6. stmt <br /> Q Unit 5 <br /> 9. street <br /> MMA <br /> to. Street `tt .' <br /> EIVVIRONMEN TMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ OUSING ABATEM1wNT C3 SOLID WASTE VEHIICCLELE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY © SOLID WASTE VEH <br /> Ok UNDERGROUND TANK(MONITORINGIRSMOVAL) © DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANC14 ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL E3 PUMPER TRUCKIYARDICHEM TOILETS <br /> CK IO TATTODP90DY PIERCING C3POOIISPA ❑ LAND USE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY ❑ OTH1;R(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above b checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail#a the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fifes 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 maximualn 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 RIMEW DATE _ <br /> EHp dOOZ-0OB <br /> snu�ans ' <br />