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^E F0 Q EHD LUG NUMBER <br /> r �� SA.N3OA UTN COUNTY <br /> E' N'V,IRONM[ENT,A.L HEALTIT DEPARTMEZ NT <br /> 7 2007 304 E Weber Ave3rd Floor Stockton, CA 95205 <br /> ,. �PL�468-3420 Fax: (209) 464-0138 Web: www.co,san joaquin.ca.usk d <br /> Er'A'I=T1,tFRVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; � BUSINESS/AGENCY:__/V O.t� - D ,- 7f1nGt,ct�l.�d'� 'F � <br /> ADDRESS: cI �b^� <br /> PHONE' [Q r ( FACSIMILE: 31��` �-�+ q <br /> TENTATIVE*APPOINTMENT DATE: tP(l D Time: I ' <br /> (Please allow 10 business days from data of applicatigiiii <br /> E <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE- REQUEST PROC S SS DAYS <br /> SIGNATURE OF APPLICANT DATE Y-q_ <br /> Department use Only <br /> J, FILEAgORESS UNIT <br /> tstreet c q-Ir Un <br /> it 1 <br /> Slrrrl qq" , �TD _Y <br /> . Gly C <br /> 3. Street l p 5 ' P . City. 5w_ p0 Aktsn '�6 Unit2 �\ <br /> i. street 9-to CAQ4: City GD - ,F F <br /> 5, Slreet ! -!y �Unit 3 <br /> G. Streettv" -0,ty uozu <br /> 7. sheat t.ti S Gtv l..a>�L; _ Unit 4 <br /> A. $�rrrt ( Z.4 ��e - Gly --U <br /> 5. Street cily ❑ Unit 5 <br /> t0, $Irr.rl G <br /> tv <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 1¢ OTHER CLEANUP SITE(NON-LOP) Li FOOD FACILITY C1 SOLID WASTE VEHICLE <br /> )!� UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> 1t HAZARQOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> (1-0-TIERED PERMITTED FACILITY ❑ MOTELMOTE:L LI PUMPER TRUCKrYAROICHEM TOILETS <br /> ❑ TATTOO/QODY PIERCING ❑ POOLISPA C3 LAND USE APPLICATION SITES <br /> ID MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten 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 /> GONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> LHD 40-02-009 . <br /> 8!012003 <br />