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DATE f;ECEIVED EPC)I.OU NUMNtF( <br /> — SA.N JOA.QUIN COUNTY <br /> � 1 II,v;��_� IID <br /> h�� IBJ IL l �!:NVIRONMENTAL REA>LTH D]:PA:R1-TIENT <br /> 304 E Wcber Avc 3rd Floor Stockton., C.A.95205 <br /> UCU N 1 20�j09) 468-3420 Fax: (209) 464-0138 Web- www,co-san-joaquin.ca.us/ehd '070 <br /> �i�V1R0NI' ir"NT FAJ1-1 PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT; ��l''��.,5 � l"!�o-`� BUSINESSIAGENCY: fv I 1 I/vC�errv� Ay sJC. <br /> ADDRESS: )�>>11Tyv <br /> PHONE; D-0 l - -S 6 Q I FAGSiMiLE: o�C7 CI 36 1 —7 U <br /> TENTATIVE"APPOINTMENT DAT �•e(' 3 � Time. <br /> (Please allow 10 business.days from date of application submittal) <br /> CHECK 13OX TO EXPEDITE RE U ST-$93.0 EE—REQUEST PROCESSED iN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE d <br /> Depertmr'nl Usc Only <br /> rlLH ADDR' SS UNIT <br /> sfrcel L W 45'( ,JvC�.! J-t- My. {' brj '2_I&p 7&J E3 Unit 1 <br /> 2. 3lree( �/�/£ �(� _ Ctl �r ' /" y� �1Y <br /> 3. Slrrrl b� �e. r' '�. city Unit,� `` <br /> CII 5)" 0-j �� ✓ <br /> 1r'� d�l` ,c c+l� S'�v�K d Unit 3 <br /> e. sve l g �1 e S� W C.ao f' �J_ . cll /i oG . / / ,/ <br /> 7- Street 7 "�U� � Cll J N' 1� Unit 4 <br /> 55�t;�'u,� 1� <br /> g,r , G„ ❑ Unit 5 <br /> Jp, $Ircht Cilv <br /> ENViRONMENTAL HEALTH DEPARTMENT FiLES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLiD WASTE FACILITY <br /> E9 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY D SOLID WASTE VEHICLE <br /> E� UNDERGROUND TANK(MONITORING(REMOvAL) J DOG KENNEL 0 DAIRY <br /> O�HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> In TiERED PERMITTED FACILITY ❑ MOT5UHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 1:7 TATTOO/80DY PIERGNG <br /> ❑ POOL!&PA ❑ LAND USE APPLICATION SiTES <br /> ❑ MEDICAL WAST_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 appiication. 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 APPOINTME-NT DATE TIME <br /> DATE CONFIRMED PHONE= FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ENO ae-oz-O�G M <br /> mlu2oa3 <br />