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DATE RECEIVED EHD LOG NUMBER is SAN JOA N COUNTY ®� ENVIRONMENTAL HEALTH DEPARTMINT 304 E Weber Ave 3ra Floor Stockton, CA 95205 Z' I (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.US/ehd PUBLIC RECORDS RELEASE APPLICATION APPLICANT: O y. Ji' l L/ ADDRESS: PHONE: 6 C J�j FACSIMILE: 3�l TE ATIV0'?E* APPOINTMENT DATE: / ® c/t47-o til Time: (Please allow 10 business days from date of application submittal) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONPfWtD APPOINTMENT DATE: TLNCE ATE (t[VFtRNIED PH.N FARC 4;11 RE IMJED YES EHD 4"2-006 8/8/2003 CHECK BOX TO EXPEDITE REQU - $93.00 FEE — REQUES CESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICAN DATE ` v2 91-7-67 Department Use Only FILE ADDRESS UNIT 1. Street �'Ve fXL City c'! eA '"%o ❑ Unit 1 2. Street ci 3. Street ci ❑ Unit 2 4. Street ci 5. street city ❑ Unit 3 6. Street ci 7• Street CR El Unit 4 S. Street ci 9. street Ci ❑ Unit 5 10. Street Ci ENVIRONMENTAL HEALTH DEPARTMENT FILES ❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FAC I i ❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE ❑ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY ❑ HAZARDOUS WASTE GENERATOR )k CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL,,�� 13PUMPER TRUCKIYARD/CHEM TOILETS 13 TATTOOIBODY PIERCING E3 POOLISPA13 LAND jIEO�I.t.('n�, /7. MEDICAL WASTE FACILITY E3 OTHER (PLEASE SPECIFY)�T X -4E3 L'- 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONPfWtD APPOINTMENT DATE: TLNCE ATE (t[VFtRNIED PH.N FARC 4;11 RE IMJED YES EHD 4"2-006 8/8/2003