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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �J EN AONMENTAL HEALTH DEPARTONT <br /> S E P 12 20 . 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> 1309)468-3420 Fax: (209)464-0138 Web: Ww'W-Co-san-joaquin.ca.us/ehd q% <br /> F-WIRUNMENT HEALTH <br /> PrRM1T/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:/ V t k►�'/ L O 0' BUSINESS/AGENCY: C Cr �c, I`-� C c h y1 a )0 <br /> I (� <br /> ADDRESS: Cirlw,'G, tee -r Cr . C>, rT 2 <br /> PHONE: 2 Q q Z3t1 0-.51119 FACSIMILE: 2-0 9 Z 3 IJ o J� <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) t^ <br /> E CHECK BOX TO EXPEDITE REQUEST- 93.00 FEE—REQUEST PRO C SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE L � _ <br /> Department Use Only <br /> FILE ADDRESS UNI <br /> Street S C- tP C( k R 1 1 a S Y p a-1 <br /> 2. Street 2,5 n7 Y 0 El Unit 1 <br /> �t 3. Street Z701 C G , <br /> �+ 1 <br /> 4. Street 1 d F v iA El nit 2 <br /> , <br /> S. Street Q cityl� <br /> Ti Street 2 2- Ci Unit <br /> /�" <br /> 7. Street 2. �,r cityn <br /> e. Street C "i 1i U Unit 4 <br /> 9. Street ,$ r-jty <br /> ❑ Unit 5 <br /> ,0. Street G S E P L:JJ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES .. S" <br /> ��I.INDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> �' OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 4d" UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 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 /> RUSH <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE - FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHO 48-02-006 .{ /�,)/�► �/ ✓1 /�yt j-� -}' (� / <br /> 8!8/2003 -Tr i f L,,! /1 � t '1 1� a/s �o r ! G m lJ l�C�til <br />