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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> OCA (209)468-3420 Fax: (209) 464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> „ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 206 6,\ Ec,C c?) BUSINESS/AGENCY: I`I <br /> q <br /> ADDRESS: _10� 5�l"� a-Q Vl) Lo JL� <br /> PHONE: 3�P —3� 1 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- I b I I 1104 <br /> Department Use Only <br /> FILE ADDRESS 1 UNIT <br /> '.,N ii•M• 1. Street 0-4 N. S<-kA"N S-t . cit, uock z <br /> S,scree t L 34-i-- (air tsva W a S-13 -U5, Z o ❑ Unit 1 <br /> y t&0 f t 5l. street 2W Sl S. Pty a.ar tN cit, S+-b ct , *j ❑ Unit 2 <br /> 4. Street 1 3 Moo at, <br /> S. street 51 S�j E, Wt a.' city Unit 3 <br /> 7p 6. Street 3.7-40 C-- CtVC-Y1/�St �Y �Ve ` A)r Gty t-1 <br /> 7. Sweet 3-;:t8 2- E. &uc� Aim AJ/--a S Unit4 <br /> S. street &trt-.% V\ L ftv—CIU r0ty5�'uC.IG<1-t� ZZ <br /> 9. Street t)S t S E , 1'1/1 a:+V\� SA , r aty S+o Cnit it <br /> 10. Street ft `I N• PA-Vi'uh f 1/y V'P-I aty c26lic-VzP— -7 J6 NLI: I <br /> .(¢ \�. - '�'^^'�\1) r4t. -)e ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> FW <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACiLr Y <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> j� HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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 r 'e <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 APROINMENT DATE <br /> 1 TIME <br /> 'PATE CONFIRMED PHONE FAX II�ITIAI.S <br /> -REVIEWED YES NO REVIEW DATE..; :...•':..: <br /> END 48-02-006 _ <br /> 8/8!2003 <br />