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END LOG NUMBER <br />I��'��� � Tv SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />APR 2 9 200�42pg 304 E Weber --Ave 3`a floor Stockton, CA 95205 <br />rldVEUNMENT HE7-�LI {468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />P�RM1T/SERVICES PUBLIC RECORDS RELEASE APPLICATION 1199 <br />APPLICANT: <br />ADDRESS: <br />BUSINESSIAGENCY: �� �nii' ✓��1 GAG�� Q.(_ <br />PHONE: ( 425 '1 Z ' 15 ( FACSIMILE: (Li2S� j' 7- - 16 00 <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Plaasa allow 10 bmineas days from data of appilcation submktaq <br />CHECK BOX TO EXPEDITE RE EST - $93. E - RE VEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICAUT� <br />A n <br />,PFS 30 20C✓ <br />DATE Ll 'II_ A 0 q P � 1. <br />9 <br />6/ <br />r.� N 1 - <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />D Unit 1 <br />[] Unit 2 <br />Unit <br />Unit 4 <br />❑ Unft 5 <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />In HOUSING ABATEMENT <br />❑ SOLID WASTE FACILrrY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILriY <br />-70 <br />.. 1 <br />,Vt <br />❑ UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTEL/HOTEL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOO/BODY PIERCING <br />❑ POOLISPA <br />IMI��MIr�,������� <br />- <br />...�._ <br />r.� N 1 - <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />D Unit 1 <br />[] Unit 2 <br />Unit <br />Unit 4 <br />❑ Unft 5 <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />In HOUSING ABATEMENT <br />❑ SOLID WASTE FACILrrY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILriY <br />❑ SOLID WASTE VEHICLE <br />,Vt <br />❑ UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTEL/HOTEL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOO/BODY PIERCING <br />❑ POOLISPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of flies 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 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 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 applican may requ re a .00 epnreview. <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 45424% <br />C' 7KNI <br />IN <br />TOO HOOHS 099TZLC9ZV %Yd 2t:CT 1UI1 VO/6Z/VO <br />