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- DATE RECEIVED _ LI-10 LUG NUbla_th <br /> %) ` SAN JOAQUIN COUNTY � <br /> EN, r]�ONMENTAL HEALTH DEPARTivIENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> SEP 2 4( 8 468-3420 Fax: (209) 464-0138 Web: www.co.san-j*oaquin.ca.us/ehd <br /> cNVIRO1iT"',fF2RKENI VICES <br /> 1516 <br /> oFRP�tiT'SHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �VI,42T 4vgBUSINESSIAGENCY: <br /> ADDRESS: L'7t0 <br /> PHONE: G Y-0 —LZ -3 g FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 10/ T Time: *1 !^ <br /> (Please allow 10 business days from date of application submitt i) <br /> El CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS V <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> Street Z3 / N. �r�. /Rn•t T CityC /t/ E]N Street Z� 4 :r'../nom.--� �-�" Ot 1•V-•.-.L �e Unit 1 <br /> 3. Street cay El <br /> Unit 2 <br /> d. Street Lil <br /> s. street Oty Unit <br /> 8. Street C <br /> r. Street L MY P0 Firp Unit 4 <br /> 8. Street Ot <br /> 9. Street <br /> City <br /> (? 0 Unit 5 <br /> 10. Street Ci 2Gua <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 8.OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UHUNDERGROUND TANK(MONITORING/REMOVAL) ElDOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES _ <br /> ❑ MEDICAL WASTE FACILITY Cl 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 mail 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 END 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 /> EHp 4842408 <br /> VU2003 <br />