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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: w,,vw.co.san_joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C� BUSINESS/AGENCY: <br /> —T <br /> ADDRESS: <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 IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 0 Department Use Only <br /> MFILE ADDRESS / UNIT <br /> 1. Street 2�2 J / 2Y Z-3 E• I l r/� Av2 cityE a(��'2 ❑ Unit 1 <br /> 2. Street city <br /> 3. Street city ❑ Unit 2 <br /> 4. Street c' <br /> 5. Street city ❑ Unit 3 <br /> 6. Street C' <br /> ty <br /> 7. Street CityUnit 4 <br /> 8. Street city <br /> 9. Street city ❑ Unit 5 <br /> 10. Street Ci <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ 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) 464-0138 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 ill be processed the next business day. <br /> CONFIRMED APPOINTME DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YOE NO REVIEW DATE <br /> EHD 48-02-006 <br /> 8/8/2003 <br />