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02/16/2001 FRI 16,55 FAQ 2094OR2999 SJC PUBLIC WORKS � X0011001 <br />1A.FM <br />DATA �IvtTo S�tN ,OA(�1CJiN COUNTY EHD Loc NUMBER <br />'8 6 2007 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />f 1ENT, lEALT <br />�.� 304 E Weber Ave 3"' Floor Stockton, CA 95205 <br />@ �) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin_ca_US/ehd <br />1.7' <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT. Claudia Gemberling BVSINESSIAGENCY: San Joaquin County Public Works Department <br />ADDIyESS: 1810 E. Hazeltoa Avenue, Stockton, California 95205 ~ <br />PHONE: 953-7624 FACSIMILE: 468-2999 <br />TENTATIVE* APPOINTMENT DATE <br />Time: <br />(Please allow 10 business days from date of application submittal? <br />0 CHECK BOX 70 EXPEDITE REQUEST • $93.00 EEE -REQUEST PRQCE$SED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT � LCa c!� � DATE <br />APPLICANT <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Department Use O Wy <br />UNIT <br />El Unit 1 <br />Ej Unit 2 <br />0 <br />Unit 3 <br />Unit 4 <br />F] Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) a uousING ABATEMENT ❑ $OM WASTE FACILITY <br />OTHERCL.EANUP SRE (NON -LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br />UNDERGROUND TANK (MON(TORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR C1 CHICKEN RANCH Cl PKG TRF.ATMENT PLANT <br />CI TIERED PERMIT7l=) FACILITY ❑ MOTELMOTE[, f7 PUMPER TRUCIVYARDICHEM TOILETS <br />0 TATTOOIBODY PIERCING ❑ P00l JSPA ❑ LAND USE APPLICATION SrrES <br />C3 MEDICAL WASTE FACILITY © OTHER (PLEASE SPECIFY)__ _ <br />1 List up to ten addresses 1n the space above. Select the type(s) of files from the list above by checking v <br />the appropriate box(es). At least one filo type MUST be selected. F xto (209) 464-0938 or snail to the <br />x _ <br />address indicated above. <br />2. EHD will notify ilia applicant if any EHD Files exist An appointment for review will be Confirmed " <br />approximately five business days but no later than ten (90) days after receipt Of application. The files <br />will be hold for a maximum of five business days for review. Appointments shoufd 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 fife reviews by the same applicant may require a $93.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be confinned with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />I t QCT~ 3? VAr <br />-... <br />TM. <br />oto 4&a40G <br />vstmal <br />FILE ADDRESS <br />r. <br />s�eut N 7 oYn fbn R", U.S <br />z <br />s� g659 cv N <br />3. <br />Sbeet <br />d. <br />St—i CAY <br />5. <br />sfi em city <br />6. <br />$Goa( <br />7. <br />SWe4 city <br />L <br />sem CHY <br />s. <br />ShV4( QEY <br />30. <br />sGe� <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Department Use O Wy <br />UNIT <br />El Unit 1 <br />Ej Unit 2 <br />0 <br />Unit 3 <br />Unit 4 <br />F] Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) a uousING ABATEMENT ❑ $OM WASTE FACILITY <br />OTHERCL.EANUP SRE (NON -LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br />UNDERGROUND TANK (MON(TORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR C1 CHICKEN RANCH Cl PKG TRF.ATMENT PLANT <br />CI TIERED PERMIT7l=) FACILITY ❑ MOTELMOTE[, f7 PUMPER TRUCIVYARDICHEM TOILETS <br />0 TATTOOIBODY PIERCING ❑ P00l JSPA ❑ LAND USE APPLICATION SrrES <br />C3 MEDICAL WASTE FACILITY © OTHER (PLEASE SPECIFY)__ _ <br />1 List up to ten addresses 1n the space above. Select the type(s) of files from the list above by checking v <br />the appropriate box(es). At least one filo type MUST be selected. F xto (209) 464-0938 or snail to the <br />x _ <br />address indicated above. <br />2. EHD will notify ilia applicant if any EHD Files exist An appointment for review will be Confirmed " <br />approximately five business days but no later than ten (90) days after receipt Of application. The files <br />will be hold for a maximum of five business days for review. Appointments shoufd 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 fife reviews by the same applicant may require a $93.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be confinned with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />I t QCT~ 3? VAr <br />-... <br />TM. <br />oto 4&a40G <br />vstmal <br />