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VEEHD LOG NUMBER <br /> (AT�TE�RRECEI ED SAN JOAQUIN COUNT <br /> Do `'1J ISD ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> AUG 13 209) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> r <br /> APPLICANT: K(tA-N NA��Pr ,AJV BUSINESS/AGENCY: 5-Teovs eN'ilf-ONMENTAL, inks <br /> ADDRESS: 3330 CAMC-f_0rJ 'PAR.k bf,, 41550 CAh`e"rj ?A-P-x CA 0IS68L <br /> PHONE: 530 6,'- 600 -4 FACSIMILE: 530 636 60057 <br /> TENTATIVE*APPOINTMENT DATE: Q 1 13 to (+ Time: 0S:00 h^a <br /> (Please allow 10 business days from date of application submittal) htL {L <br /> f�+ CHECK BOX TO EXPEDITE REQUEST-$ FEE- QUEST PROCESSED IN 3 BUSINESS DAYS <br /> ((( <br /> SIGNATURE OF APPLICANT DATE 0811_310(f <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 57j�Z 1. street 2-175' COVNILy C,V4b V1t4C- aty 57 ❑ Unit 1 <br /> `J tt If z 2. Street 5 � 1 city •t �/ ��-7�1I <br /> 3. street Z „ city ;! MO-441' F1 Unit 2 <br /> 4. Street 2-909 a city <br /> 7-r,ta <br /> s. street city Unl <br /> 6. Street G <br /> 7. Street City Unit 4 <br /> 8. Street Ci <br /> 9. street city ❑ Unit 5 <br /> 10. Street ri <br /> l. <br /> Y ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J� UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ MOTEL/HOTEL E3 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY <br /> ❑ TATTOO/BODY PIERCING 13POOL/SPA 13LAND USE APPLICATION SITES <br /> E3 OTHER(PLEASE SPECIFY) <br /> 13 MEDICAL WASTE FACILITY <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 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. RUSH <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX' INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD48.02.006 'a-725 Cour lam- 6�- Z&(t <br /> 8/8/2003 <br />