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EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> o ENVIRONMENTAL HEALTH DEPARTMENT <br /> n 304 E Weber Ave 3 Floor Stockton,CA 95205 V6 *& ' <br /> 10 - �( 9)468-3420 Fax: (209)464-0138 Web:v�%mco.san joaquin.ca us/ehd <br /> NVWaAwNR�j��SH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 2U� 1i"f BUSINESSlAGENCY: <br /> CA 6 7th <br /> ADDRESS: <br /> PHONE: /G" 6��— FACSIMILE: <br /> TENTATIVE*APPOINTME T ITE: <br /> Time: <br /> (Please al 0 business days from date of application submittal) <br /> ED CHECK BOX TO EXPEDITE REQUEST-$ 0 EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE 0 <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> 0..E ADDRESS r <br /> o S ,qv �2 v e, , e. k•�' ;:;❑r Unit 1 <br /> 1. skeet <br /> 2. street <br /> G ❑ Unit 2 <br /> 3. street \(1+ <br /> Unit 3 V� <br /> 5. street <br /> 6. Street Unit 4 <br /> 7. street <br /> 1 7 N <br /> 9. Skeet Unit 5 <br /> Ci <br /> 9. Street <br /> 10. Skeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL 13 DAIRY <br /> UNDERGROUND TANK(MON170RINGlREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY [I pOOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOlBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> files from the <br /> 1, List up to ten addresses Inthe <br /> leastonefile type MUST be ove. Select the t acted f Fax to(209)464-0138 or ma 1 t ist above Oy checking <br /> the appropriate box(es). <br /> address Indicated above. y An appointment for review will be confirmed <br /> Z. EHD will notifytheapplicant if an EHD files exist. <br /> approximately five business days but no later than ten-(10)days should be scheduledceipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments <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 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 /> g. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED gpPO1Nj.MENT.DATE <br /> TIME <br /> OA' E CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES <br /> NO REVIEW DATE. <br /> 48-02-006 <br /> Mnn, <br />