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May 05 04 01 : 18p SJC PUBLIC WORKS 468 2999 P• 1 <br /> J... <br /> EHD LOG NUMBER <br /> DATE RECEIVED ,e V SAN JOAQUIN COUNTY <br /> � I <br /> sll`,��� �' j` <br /> U UE �- 1 ='` ENVIRONMENTAL HEALTH DEPARTMENT <br /> ((� 304 E Weber Ave 3`s Floor Stockton,CA 95205 I SOV <br /> MAY 0 5 2P�)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLItANr._ Claudia Gemberling BUSINESSIAGENCY: San Joaquin County Public Works Department <br /> ADDRESS; 1810 E. Hazelton Avenue, Stockton, California 95205 <br /> PHONE: 953-7624 FACSIMILE: 468-2999 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) e <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS _I/ O <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. seeei 3 30 S. -Fro-" •IGGd ❑ Unit 1 — <br /> z Su..1 00 5. '/ f c <br /> ,. Se I 5 unit 2 <br /> 1. eewl S. 011 G <br /> s. suae Zell DO .S. -f O! Wnit V <br /> e. Y <br /> r: soca S. D JVV 4 <br /> e. sax nit 5 <br /> 9. 51na1 <br /> 0. eewl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) 0 DOG KENNEL YAAIRY <br /> HAZARDOUS WASTE GENERATORy+CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY (7 MOTELMOTEL 0 PUMPER TRUCK(YARDICHEM TOILETS <br /> TATTOOIBODY PIERCING In POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 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. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD tiles 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 /> CONFIRMEDAPPOINTMENT DATE -- TIME <br /> DATE CONFIRMED PHONE FAX INITIALS- _. ...._. <br /> REVIEWED YES ,NO REVIEW DgTE <br /> eao umaa <br /> enr:eor <br />