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U0/Ub/ZUUI AL1) 10:Jb P'AA ZUY4662YYU SX YUHLIC WORKS 1Q002/002 <br /> '1 <br /> ��/l��Cl SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> (C�k ENVIRONl1ENTAL HEALTH DEPARTMENT <br /> J �p 1UN d V20077 304 E Weber Ave 34 Floor Stockton,CA 95205 <br /> (2b9)468-3420 Fax:(209)464-0138 Web: www.co.sanjoaqummu mu hd <br /> ENVIRONMENTHEALTN <br /> �o PERMj T/SERV1PF.S PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT: Claudia Gemberling BUSINESS/AGENCY. San Joaquin County Public Works Department <br /> ADDRESS: 1810 E. Hazelton Avenue, Stockton, Califomla 95205 <br /> PHONE: 953-7624 FACSIMILE: 468-2999 <br /> TENTATIVE`APPOINTMENT DATE: Tim: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST--S93.00 FEE-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l A 2.>k-Y�(J l kif DATE li �o-,9 7 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 0 seoei e u f-84- 0c5 <br /> z sea L 0 ❑ Unit t <br /> `, a $vee •f: E5 ❑ Unit 2 (� <br /> 42 \V <br /> ( 5" Baan <br /> l$ �Unit3 <br /> Y- JT • te5 Ala 0 a Unit 4 <br /> Q <br /> s. awa /(-iY d7.f' N+-'r' ❑ Unit 5 <br /> ,o. simd <br /> 7M 5, i(7 oz.s ati 1 <br /> J <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON{OP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ...111333 UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY M MOTELMOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> 10 TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES ,. <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)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 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 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 /> zC3I,'EF.1wEtlP4iffAlTlyl <br /> ... <br /> DA' Et�fYFIRMEI9 <br /> elm aaraoe . ..._ .•....•. <br /> W U <br />