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BATE RECEIVED _, EHD LOG HUMBER <br /> ,a SAN QU <br /> JOAIN COUNTY <br /> P11F— "':! , ' :- ~ ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209)`468-3420 Fax: (209) 464-0138 Web:www.co.sanjoaquin.ca.us/ehdC4 <br /> F� ��1ni {t}iiir kC"\j � PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SUSINESS/AGENCY: 1`;fA'1 Q - <br /> ADDRESS: �0l+n"m-vh 114Q Wi <br /> PHONE: FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ' J b I i i I 0 k4 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. Street L 0� N, S�1n 6 0 l S-t . c� l.a rpt <br /> S� (��r vk W city <br /> S� 4k1i5�• Z GO <br /> dUnit 1 <br /> '4'll al street 2{n 1 1 S R.✓ �c� . W d 5�c.'E b1 09 L f D Unit 2 �. <br /> <. Street J5113 C. YY\vot•n SA, ot, S-k'b r-lam-tr,-, <br /> s. street 51S�j G, Y1tw v` S-� F ci S ac.� -tom �1� Unit )dp) <br /> 6. Street 3-V40 C, CS'Ur VAS L v&v-c - A)r aty <br /> 7. street 3-�$Z C. L/—�uc ftV--,_ A)}mac,& S5 , c Yt>� Unit 4 <br /> 4—B. Street �J�� �. '� �S, t"IV IV ra S'` r- e- ZZ, <br /> 9. Sweet r}S i�i [ m a-A v\ S-1 . u S+D LI�tC 6�7 ). <br /> nit 5 <br /> 10. street 09— '51 `i N. ve � GMx <br /> off- ' . ENVIRONMENTAL HEALTH DEPARTMENT FILES -+F> <br /> � �� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELfHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO186DY PIERCING 0 POOLlSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above..Select the type(s)of files frorn'the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(249)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 reorganizers 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 ireWell <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 /> CQNF'iRMEDIPPOINTMENT DATA :r..:_:. TIME <br /> DATE CONFJRMED �T' PRONE FAX' ll�(I"CIALS <br /> REVIEWED YES NO REVIEW DATE'... .. <br /> EHD 48.02.006 - <br /> &1=003 <br />