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DOC-09-05 10:08A ADR vivanmental Group 916 � 6688 P.01 <br /> DATE R£GElVEO <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> REDLSV ENVIRONMENTAL HEALTH DEPARTMENT' <br /> �J <br /> 304 E Weber Aver 3rd Floor Stockton,CA 952()5 <br /> Ul= _ �q(N(§8-3420 Falx: (209)464-0138 Web:www.Co.san-joyuin.cx,us/ehd <br /> VIROM-N I HULTPUSLIC RECORDS RELEASE APPLICATION <br /> PER <br /> APPLICANT: - BUSINE5SlAGENCY: I L <br /> ADDRESS: f� p <br /> PHONE: 9A1- FACSIM LE: a �y <br /> TENTATIVE"APPOINTMENT I?ATE: Time, <br /> (Pleaso allow 40 buslnass days from date of application submittal) <br /> CHECK BOX To EXPEPITE.REQ5r-$93.00 F E—ItEQIIEST PROCESSED IN 3 BUSINE$S DAYS <br /> SIGNATURE OF APPLICANT .; - DATE <br /> p Department Use Only <br /> FILE ADDRPSS UNIT <br /> 1 street ❑ Unit t 14 <br /> 2. Met <br /> 3. Sires+ � —..�-�.�...�.. � Unit 2 <br /> dt � <br /> 4. SVee! <br /> S. street Unit 3 ,A\\N' <br /> a. sued a Unit 4} <br /> s- svaa+ Utv unit$ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> t UNDERGROUND YANK(USTJ CLEANUP SITE(LOP) 10 HOUSING ABATEMENT © SOLID WASTE FACILITY <br /> OTHER CLEANUP SITi (NON•LpP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNOE 3tGIiQUND TANK(MON[TORINGrREIJIOVAL) IO 13OG KENNEL C1 DAIRY <br /> 'R HAZARDOUS WASTE GENERATOR 0 CHICKEN 17ANCH C] PKG TREATMENT PLANT <br /> D TfEREQ PERMrrTEO FACiLI7Y In moTELINOTEL PUMPER TRUCKIYAFD/CHEM TOILETS <br /> CI TA-ryOOj130DY PIERCING 0 PGQLlSPA O LAND USE AFPLIGAnON SITES <br /> 0 MEDICAL WASTE FACILITY CI OrMER(PLUSE SPECIFY} <br /> 1. List up to tan addresses in the space above. Select the type($)of tiles from the list,abbye by checking <br /> the appropriate box(es). At least one file ty{ae MUST be selected- l=ax to 209 454-t]1 S8 or mail to the <br /> address indicated above. r <br /> 2. EHD will notify ttte applicant if any ESD 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'stafat the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. '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 - r <br /> GATE CONFIRMED <br /> PHONE FAX, INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> gHD 48 9:66r- <br /> 6Mr26C7 <br />