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tr1r)LOG NUMULf t <br /> ED <br /> HE00W <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 171EALTH DEPARTME NT <br /> A <br /> N0 2 0 2007 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> ENARONMENT HEkJW)468-3420 Fax: (209) 464-0138 Web: www-co,san-joaquin.C�-Is h;� <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT, BUSINESS/AGENCY: <br /> ADDRESS. 470 2. <br /> PHONE: 3ti—+ — -3 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: -rime'.---.9 CFO <br /> (please allow io business days from date of application submittal) <br /> NI.Z <br /> CHECK BOX TO EXPEDITE REQUEST/•f <br /> EQUF-ST-$93.00 FEE—REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT X DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1, Street DIV ❑ Unit 1 <br /> 3 9 'IN - <br /> 2. ► Gil <br /> Gil <br /> a. set 3937- c1l 0 Unit 2 <br /> 4. Sir 5 4 (Al <br /> 5. street 3'3 A 4t C'cl LAV Unit 3 <br /> 0111 1-10 Unit 4 <br /> 7. Street <br /> 0, Street city. <br /> 9. sirmt Unit 5 <br /> 10. Sir"a <br /> ENVIRONMENTAL HEALTH DEPARTMEN <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOUSING ABATEMENT 0 SOLID WAS <br /> 7Z <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY C3 SOLID WASTE V CLE <br /> UNOEPGROUNDTANK(moNrroRING1Rr=MOVAI-) 0 DOG KENNEL 0 DAIRY . <br /> HAZARDOUS WASTE GENERATOR), 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY�( 0 MOTEUHOTF-1- Cl PUMPER TRUCWYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ID POOLJSPA C3 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY E3 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-.2r mailtothe <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 recdipt of application. The file <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 <br /> application may be submitted when the file is available, 1 <br /> 4. Any flie 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 /> EHD 40-024006 <br />