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DATE RECEIVED •� ••�^ �� <br />(�� SAN JOAQUIN COUNTY <br />�' - ! `� G � '!, !�� E NMENTAL HEALTH DEPAR <br />APR 0 6 200 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />209) 468-3420 Fax: (209) 4640138 Web: www.co.san-joaquin.ca.us/ehd <br />ENVIRUMMEAT HEHLI H <br />PER..PiT/SERV10ES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT; �fi�j� N�(L(i it L� BUSINESSIAGENCY: <br />ADDRESS: 3 SSS / ` vu � hZ,t _0_± e <br />PHONE: 610— °!i- 839 Lf FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal) <br />F <br />Sl( <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />&eL" <br />ERGROUNDTANK (UST) CLEANUPSITE (LOP) <br />ERCLUPSITE (NON-LOP)NDERGROUND TANK (MONITORNGIREMovAL) <br />AZARDOUS WASTE GENERATOR <br />❑ TIERED PERMITTED FACILITY <br />❑ TATTOOA300Y PIERCING <br />❑ MEDICAL WASTE FACILITY <br />_0 <br />Department Use Only <br />INL <br />UL AM <br />UNIT <br />nit 1 <br />Jag Unit 2 <br />(1' <br />Unit 3 <br />Unit 4 <br />❑ Unit 5 <br />❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />❑ DOG KENNEL ❑ DAIRY <br />❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETN _ <br />❑ POOLISPA LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY) <br />1. Ust 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 />;CONFLRMED AP!P®INTMENTDATE TIME <br />ATE -6 `:PHONE FAX INITIALS <br />kEVIEVI/ED YES 'NO REVIEW DATE <br />END 4a-024)" - <br />C? T,, <br />