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EHD LOG NUMBER i <br /> DATE RECEIVED SAN JOAQ6N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MEWED 304E Weber Ave 3rd Floor Stockton,CA 95205 <br /> N 2 2004 (209) 46$-3420 Fax: (209) 464-0138 Web:www.co.san-joaquin.ca.us/chd <br /> JA <br /> �NVI tgC j PUBLIC RECORDS RELEASE APPLICATION <br /> PAPPILICANT! V�� t S � 1 1' HUSINESSIAGENCY: U <br /> ADDRESS: LIQ 17U G J <br /> PHONE: �� `7 p x FACSIMILE: 20 r <br /> TENTATIVE'APPOINTMENT DATE: Mme' <br /> (Please allow 14 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 0 FEE— UEST PROCESSED IN 3 BUSINESS DAYS L <br /> DATE /2 Q <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> EStreel <br /> et .ZZ/o i Etc Et-5 -K'1 bN ❑ Unit 1 Lj <br /> 01 <br /> Street <br /> Ci Unit 2 <br /> et <br /> / <br /> et <br /> Ci Un1 <br /> elCi <br /> eteeteet Unit 5 <br /> Cieeteet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP} ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ pOO,KENNEL ❑ DAIRY <br /> t UNDERGROUND TANK(INONITORINGIREMOVAL) E3 C2 <br /> RANCH ❑ PKG TREATMENT PLANT <br /> '❑ HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TIERED PERMrrTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> Cl TAITOOIBODY PIERCING ❑ OTHER(PLEASE SPEGIFY} <br /> ❑ MEDICAL WASTE FACILITY <br /> space above. Select the type(s)of files from the list above by checking <br /> 1. List up to ten addresses.in the <br /> the appropriate box(es). At least one file type MUST be selected. Fax It 209 464-0138 or mail to the <br /> address indicated above. <br /> r review will be confirmed <br /> 2. EHD will notify the applicant daysYEHD o Later than An <br /> (10) days afteappointment r receipt of application. The files <br /> approximately five business <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 /> CONFIRMED'APPOINTMENT DATE TIME <br /> DATE CONFIRMED "'PHONE FAX" ;INITIALS - <br /> REVIEWED YES NO REVIEW DATE <br /> EMU 43-02-006 <br /> OA/2003 <br />