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)ATE RECEIVED EHD LOG NUM9Ef2 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 W www.co.sanoaquin.ca.us/ehd <br /> AA <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> a,�a p <br /> APPLICANT: tel) �2.---- BUSINESS/AGENCY: <br /> ADDRESS:t�3 TC1�S O`/� <br /> PHONE: � � �� L G�V+ G " CS e — J �2 <br /> FACSIMILE: Sl/ <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$ <br /> �9j 0000 FEE R UE3T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT sr��= DATE <br /> Department Use Onry <br /> FILE ADDRESS UNIT <br /> 1. Street ��� CI T C <br /> © Unit 1 <br /> 2, ssrw city <br /> 3. street city <br /> ❑ Unit 2 <br /> 4, city <br /> S. alrett, city <br /> © Unit 3 <br /> 9. street clixim <br /> 7. Str city Unit 4 <br /> n <br /> treet ci Unit 5 <br /> treet CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C 1 HOUSING ABATEMENT C3 SOLID WASTE FACILITY <br /> CT OTHER CLEANUP SITE(NON-t_OP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING O POOLISPA © LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 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, Fix to(209)464-0138 or mail do the <br /> addrlss 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 0 r PHONE FAX ' INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Z0 3Jtid 1b1N3WN0HIAN3 SV63 /�`' 66CS9880TS 86:TT 6002/60/L0 <br />