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DATE RECEIVED SAN JOA.QUxN COUNTY 41 <br /> EHD LOG NUM8l,K <br /> E <br /> (5�1���;� � <br /> LL 1I U ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Wcber. Ave 3d FIoot Stockton, CA 95205 <br /> LILG 2 1 20Q509)468-3420 Fax: (209)464-0138 Web: www.co,m.-joaquin.ca.us/ehd 14,070 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION Zee <br /> pry-aN��T ccs n' �/j� l ��.tt n T <br /> APPLICANT: G�,A'V'm��Y ��trJ,SO'^I I - / BUSINESSIAGE`NCY: N4` I (IMpOeersj/ �j Ass-ac <br /> ADDRESS: I��. � 1sT f 7 W 1 (JV L,L�J • CA 1 5 1`2 a <br /> PHONED-09 . 36-7 -3701 FACSII/MILE: eZO q - 36 1 <br /> TENTATIVE"APPOINTMENT DATI.�e'r •. - Time_ q OU z1w <br /> (Please allow 70 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE RE UST•$93.0 EE-REQUEST PROCESSED IN 3 BUSINESS DAYS lJ 1 <br /> SIGNATURE OF APPLICANT DATE �P Id <br /> Department Use Only <br /> 51LE ADDRESS UNIT <br /> 1, slrcet 1�/e5'S .r t <br /> cliv 51 AD br-1 �j �lr/ <br /> ❑ Unit 1 <br /> z. slaei 0 W Y/z r Cil we (( <br /> 3. <br /> ss,. Srcn <br /> 66 o? El UUnniitt2 <br /> N. sN. vbp- city �ivc +� <br /> slel -e ¢f 1 <br /> se ` a �\ <br /> � <br /> 7. 3tMel .S L.-f^eelr.L, Saim S C4 •1 r' Unit 4 <br /> o, stm Sb L,�wI,.,ST e�' Qa.«•�(;<�J 51„c ,� <br /> 9. $Niel of ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> ® OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY D SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONtTORINGIREMOVAL) IO DOG KENNEL O DAIRY <br /> )7 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG'TREATMENT PLANT <br /> M TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOISODY PIERCING ❑ POOLISPA ❑ 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 mall 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 /> Ef',0 ae•az-0eG <br /> aanaps <br />