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str—ZJ—,`004 lb:28 T /'� 916 9P'1 19`f,Y Fl.0 1/0 <br /> J <br /> ,..un�c Rct.civcv - SAN OAQUI COUNTY <br /> - ``- '`J ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 ` <br /> SEP 2 9 200q 09 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> oq5�lL ) <br /> cNVIRi_ '.: <br /> Pr ::, ;hr--c PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 J or o�e{� l� BUSINESSIAGENCY: yv"'� <br /> ADDRESS: <br /> PHONE: 91(,— FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE- 1°" '2"04 Time: C> <br /> (Please allow 10 business days from data of application submittal) ` <br /> 13 CHECK BOX TO EXPEDn-E REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> // UNIT <br /> FILE ADDRESS 6 <br /> /00 V <br /> r X14 0lrS2-CJ� FOLu [I Unit <br /> r Cky , 1q Gi �c-s <br /> 3. sr�ec S G 4c�1 tS'�� �' 'l4�•` 11 Unit 2 `C1 <br /> � � <br /> F�;�d �. soffit Jct IL d I c <br /> G <br /> s. sr�c Unit J3 <br /> s. Suet <br /> Cky <br /> 7. sb .Unit 4 <br /> e. sheet <br /> 9. sx� c L" ❑ Unit 5 <br /> t0. btreet c <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> CL UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT fZ SOLID WASTE FACILITY <br /> JS OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> IR UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> n HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> R TIERED PERMITTED FACILITY ❑ MOTELJHOTEL El <br /> TRUCK/YARDlCHEM TOILETS <br /> El TATTOOBODY PIERCING ❑ POOLJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)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. EHD off at the ex ense <br /> 4. Any file not returned in the same condition as released will be reorganized by P <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 /> - 1T4E1✓:: - - <br /> Ail'1= - <br /> ED:. ,OI Th4ENT:D <br /> N FIRtI A ,.N. <br /> NO <br /> -REVIDREVIEW <br /> ...,. ,.....:. <br /> a�c ,ss, <�tt <br /> EWr <br /> EMB �cl-7i)- : !��-Ft U:� cci�t r.2,i,'15 G n'SS• !c'(�' Ud 5;_5MrAn <br /> TOTAL P.01 <br />