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ung c rcc�,rwcu 1 / <br /> _ SAN JOAQUIN COUNTY <br /> FMD Loc NUMBER ^f <br /> ENVIRON'riENTAL HEALTH DEPARTMENT <br /> 304E Weber Ave 3111 Floor Stockton, CA 95205 Z zq�c) <br /> 209) 468-3420 Fax: (209) 464-013$ Web: www.cosan joaquin.ca.us/ehd <br /> FEAR - 2 20?6 <br /> p� -r yr� <br /> '4P ( PUBLIC RECORDS RELEASE APPLICATION <br /> -SE <br /> �O�\"/Iy ' L� BUSINESS/AGENCY:_ /Vej ��, �Alc.ycJ.Gt) 1- A C. <br /> ADDRESS: Ro-z— I.,v�4nd"1%�(�,� Ujc� 7L0 � �,7Iy�l.,p <br /> PHONE- '2(7 —*3 1 FFA'CSSIIMILE: �(g_I —TZ-7 ci <br /> TENTATIVE'APPOINTMENT DATE: �/ ((t LD Time: ,5-D _ <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE.�/—�REQUEST PROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT �_—P DATE �/Z-10Lp <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> snvel SI o3 <br /> C7 Unit t <br /> s. sima G, El Unit 2 <br /> 41 A. Sbxeifeti 1_�, c, <br /> 1y. 54.P } `15 7 - �, G S. r(� � Unit3 <br /> r. s a ht 5 . 2t. X1°1 cn Sd rrt1�. Unit 4 <br /> C '; <G,Fy.,a> , <br /> Units. <br /> ,a. Shea G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILriY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL, ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> �1 TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL ❑ PUMPER TRUCKrYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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)464-0136 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 /> aocordingly. <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 /> s. '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 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> el+o<a4zaoc <br /> ¢�9ncva <br />