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,t 29 04 09: 58a 0 Environmental Group 91 48-6688 p: 1 <br /> END LOG NUMBER <br /> GATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH[DEPAR'>`MNT <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> (209)460420 Fax: (299)464-01 .8.Web:www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1'1t4�.1 = �t J. S�^s.it BUSINESSIAGENCY: to <br /> ADDRESS. ® C 4 2'O S <br /> PHONE: Cs Zt'a FACSIMILE: LC ' <br /> E"APPOINTMENT DATE: l,f—� d Time: <br /> (Please allow 10 business days from date of application subtni <br /> ECK BOX TO EXPEDITE REQUEST-$9 .00 FEE–REOU T PROCESSED IN 3 BUSINESS D Lt I Ol O <br /> SIGNATURE OF APPLICANT DATE ro Ado <br /> Department Use Ordy <br /> FILE ADDRESS UNIT <br /> ,. street a Unit 1 <br /> 2. Street 1M• J Ci <br /> 3. v G `1~ UN 2 <br /> 4. street OS 0 � <br /> S. street • LAI%Age 1��Unit3 `\ <br /> s. sues a •-) <br /> 7. street 1. city Unit 4 <br /> a. sweet 3 <br /> 9. street gg tc1tv ❑ Unit 5 <br /> 10. street Z.6 Aty <br /> G <br /> � • }LZ � . µ..ms At.�.. S ,� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 18 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13 SOLID W TE VEHICLE <br /> 10 UNDERGROUND TANK(MONITORINGIREMOVAL) 13DOG KENNEL 03DAI <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ ENT PLANT <br /> iS TIERED PERMITTED FACILITY ❑ MOTELIHOTEL CK/YARD/CHEM TOILETS <br /> ❑ •TATTOOBODY PIERCING <br /> ❑ POOLISPA E APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASES <br /> 1. List up to ten addresses in the space above. Select the p s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 12091464-0138 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. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE . FAx INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> EHO 48.02-006 <br /> 8=003 <br />