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0 002 <br /> 06/14/2004 16:13 FAX 209 948062" <br /> ` Q&TE RECEIVED <br /> -- SAN JOAQUIN COUNTY <br /> �,1- .0 1�/, �' ENVIRONMENTAL REALM DEPARTMENT <br /> 1p� 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> JUN 1 4 20109) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.US/ehd <br /> ENVIRUNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: all/ &P#-ll BUSINESSIAGENCY: <br /> ADDRESS: 0 S" <br /> PHONE: 610 3 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: �o /�7�[7 3 Time: 00 <br /> (Please allow 10 business days from date of application submittaQ <br /> CHECK BOX TO EXPEDITE REQUEST $93.00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ ./�vO DATE <br /> Department Use Only <br /> �� FILE ADDRESS UNIT <br /> 1. Street o?/ /�G �_ ❑ <br /> Unit 1 <br /> 2. Street / 5 n`� a -.L{— / <br /> / ✓�/ 3. S4ecl D JrC /JLt Q�(/ y0'd ..l— <br /> 4. Street 0 G r"/ti• cS'(</C C+ jL��— <br /> V, s. st.eet D0 8 14C+o,! a \ Unit 3 <br /> /�� E d/e L <br /> / 7. s,eet / S CY U o Unit 4 <br /> ✓ ✓ e. sheet o F�Y <br /> e. stmt (c0 G LU G E] Unit 5 <br /> 10. street oty \\� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILIVY <br /> ,19.OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY �SC SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONTTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 13ITY TIERED PERMITTED FACIL ❑ MOTELIHOTEL 1:1PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLJSPA ❑ 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(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 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 /> S. '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 /> ZNFIE�, MED APPOINTMENTIA`TE ::.TIME <br /> flAT{ CONEIRMD_.f PHONE FAX �NC{LALS <br /> t2EV1EWED YES NO REVIEW DATE <br /> EHD 4"2-006 ^? i _ ;•. <br />