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DATE RECEIVED <br />APPLICANT: <br />ADDRESS: _ <br />PHONE: <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />(209) 468-3420 Fax: (209) 464-0138 Web: w_ww.co.san-joaquin.ca.us/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />AA A_1 <br />°o.soy, <br />y6a-3�� <br />BUSIN <br />E <br />�SS/AGENCY: <br />"1I ("1 <br />TENTATIVE* APPOINTMENT DATE: <br />_ <br />TY df' S ,j qq f99a, J <br />FACSIMILE: !W-`3078 <br />Time, <br />(Please allow 10 business days from date of application submittal) <br />EHD LOG NUMBER <br />Im <br />11 CHECK BOX TO EXPEDITE RE $9 . - REQUEST PROCESSED IN 3 BUSINESS DAYS A -�- �Q!! <br />SIGNATURE OF APPLICANT DATE <br />Department Use Only <br />UNIT Arw <br />❑ Unit 1 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />❑ Unit 2 <br />® Unit <br />Unit 4 <br />❑ Unit 5 <br />'Kl,O SOLID WASTE FACILITY. UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ®HOUSING ABATEMENT p SOLID WASTE VEHICLE <br />THER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY <br />.�{ UNDERGROUND TANK ((MONITORING/REMOVAL)DOG KENNEL 0 DAIRY <br />®CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR p MOTEUHOTEL ❑ PUMPER TRtICK/YARDlCHEM TOILETS <br />0 TIERED PERMITTED FACILITY p POOLlSPA ® LAND USE APPLICATION SITES <br />O TATTOO/BODY PIERCING <br />® MEDICAL WASTE FACILITY p OTHER (PLEASE SPECIFY) <br />1, List up to ten addresses in the space above. Select the type(s) of files from the list above ny checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 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 />g. Applications received after 3:00 pm will be processed the next business day. <br />_. .... .. '-. THUG <br />