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DATE RECEIVED EHD LOG NUM96R 'Ill SAN JOAQUIN COUNTY ', ENVIRONMENTAL HEALTH DEPARTMENT 304E 09) 46 Ave 3"'Floor Stockton, CA 9520 � / (209)468-3420 Fax: (209) 464-0138 Web: www.cosan,joaquin.ca. e PUBLIC RECORDS RCLEASE APPLICATION APPLICANT: -Jf,,,.0 BUSINESS/AGENCY:�p�tl D, FYN t�pti G/1.� .f+ ADDRESS: PHONE: 3& FACSIMILE: TENTATIVE*APPOINTMENT DATE:_ I T--/-2— ( 1 0--4- Time: �a (Please allow 10 business days from data of app lieation I CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROLES U DAYS SIGNATURE OF APPLICANT DATE (-2- Department ZDepartment Use Only FILE A0DR~`5S UNIT r�� 2910 r�nnC � OI � 1� s si ,,, 29 Lfe E. [3 Unit 1 A �� , Z so _5 � • [� 3 V afl C7 Unit stmt �JS� n - -�. r 6 Unita O I 2, $heel G-�fRV �-�w+n /� K0 0. sareei 2431 0S K6l • x '2.3 3 43e, ?-A. ' — of tE`}6 1 Unit \ 6 , s. 1frp yY1 DSc, p� . e [) Unit t 31v(o3 ENVIRONMENTAL M i TH DEPAR f NT FIL W UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE 10 UNDERGROUND YANK(MONITORINGIREMOVAL)✓ O DOG KENNEL ❑ DAIRY W HAZARDOUS WASTE GENERATOR✓ ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY,/-nDAt, ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS FI TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any F-HD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the salve applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EHD 66.ORA06 '" 61LjD6)