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Ri � Dtrio�LOG aurJDc1 <br /> SAN JOAQUIN Ti <br /> ENViRONTVIENTAL HEALTH DEPA72TMI INT <br /> NU V 2 0 2007 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> F f�� )468-3420 Fay:: (209) 464-0138 Web: www.co.san joaquin.ca. s <br /> �t�4:�M!ENT r�.EA��'�{ hd 2 <br /> PEPIVIT/SWICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ►/ C.0 c7 BUSINESS/AGENCY: ©, <br /> ADDRESS: q0 S�q.o <br /> PHONE: 3VT ^ ✓ r v\ FACSIMILE:, -3 I ` LL-2_I <br /> CFO <br /> TENTATIVE"APPOINTMENT DATE: �` I �'a D Time: 9 ` <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT -���( _ DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. StrcN g���P N. nom ) }�h., fly ❑ Unit 1 <br /> 2. 5l-e4 39'31 J c 7w" `+a' C11 <br /> �. sat CII ❑ Unit 2 <br /> 4. Slr 3 f U I,�,1J. j� �A ✓ cl, /y/, <br /> 5. Street 3� , r , ' ` 5 c1t l� Unit 3 ; L/ <br /> IN <br /> 7. street J7 c2 3-2- ` " � Aj e'.^--,,,^ �(`,f CAI Unit 4 , \ <br /> 0. street 3 D L-�} _-. �1 V' `�,_,-„ \��� ca <br /> s. street ] [( f J ` �n ll C �'n: el Unit 5 <br /> 10. Slrrrt J�7 2X 1 <br /> ENVIRONMENTAL.HEALTH DEPARTMEN > <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 1:1 HOUSING ABATEMENT SOLID WAS <br /> OTHER CLEANUP SITE(NON-LOP) 17 FOOD FACILITY d SOLID WASTE V CLE <br /> UNDERGROUND TANK(MONFTORINGfRLMOVAL) © DOG KENNEL C1 DAIRY <br /> HAZARDOUS WASTE GENERATORx © CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY( 0 MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> Ix <br /> C3 TATTOO/BODY PIERCING LlPOOUSPA D LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 13 OTHE=R(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 feast 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 file <br /> will be held fora maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be immediately available for review. A <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 /> EHD 40-024)06 - <br /> srenaoa <br />