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bt=r—�—�e4 1b:�i y1 . 1 1977 916 9�1 1977 <br /> y 7��j(�('�g�'7� �r ..,,..�..... ...,,.,..,� <br /> RG�.GIVGU AN AQVRl\ 1 6Vl\TTi <br /> r` �) ENVIRONMENTAL HEALTH DEPARTMENT Aft <br /> J <br /> P 9 2Q0 304 E Weber Ave 3d Floor Stockton,CA 95205 Yvq& <br /> 209)468-3420 Fax:(209)464-0138 Web:www.co.san-joaq0n-ca.us/ehd <br /> F,� <br /> t, iH <br /> NVl <br /> P ; ; LR4'1CTS pU.BLIC RECORDS REIXASE APPLICATION <br /> APPLICANT: i r s os' 721-'SP- .._BUSINESS/AGENCY: <br /> ADDRESS: '3'S2t �e.,�e,c- inn +2oo.d. $+.,.:�- �joojf Ca0.Gsor�„+e.ti�b G14 9�$Ztea <br /> PHONE: S lie— "ttta -$y3,k FACSIMILE Q►ts+ -92"(-9taZ <br /> TENTATIVE*APPOINTMENT DATE: Ic"°Z•p`I Time: O 9 *a <br /> (Please allow 10 business days from data of application subm"tal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Depadnmt Use Only <br /> FILE ADDRESS Nr1 n <br /> a ; <br /> UNIT <br /> 9 �. straac 1S"rl . IL�`e t�: 4wJ .�or l�1A e157.�J'� fv ut/cl ® Unit <br /> 2. SMaet I mss, <br /> d - .A (� <br /> 3 -7 <br /> G s. sa®ec e Cky Unit 2 <br /> 5. Street <br /> Cky CUnit 3 <br /> 6. 6lreet <br /> T. Straw! Unit 4 \... <br /> e. strtiee Z�" ❑ Unit 5 <br /> to. $not <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT JR p souD WASTEFACILITY <br /> VEHICLE <br /> AL OTHER CLEANUP SITE(NON-LOP) E3FOOD FACILITY <br /> lR UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAzARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 13MOTEUHOTEL 13 PUMPER TRUCKIYARDICHEM 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)4+64-0138 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. Anew <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 3A0 pm will be processed the next business day. <br /> Y <br /> at• <br /> $ <br /> ENI t7 YES LN4' • REV)EW i?AT <br /> F.cto"42 �U Oct: eft U:`t'► eci�r '��2t i,�c�. .•. : 55, do �Ssii�it�G� SS...�y 7� �! CLc7. <br /> TOTAL P.01 <br />