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r y <br /> 4` <br /> Ff <br /> LJ <br /> SAN J•OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - — 304 B Weber Ave 3`d Floor Stockton, CA 95205 <br /> <<v,a 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquinca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION 91 P_.._._ <br /> APPLICANT:_ ZA `K BUSINESS(AGENCY: FV 6 Q }� <br /> ADDRESS ,e61_p)), o /� 9,G 3 �g' D <br /> PHONE: 202• -33$'Q(//0 FACSIMILE: 20j- !g:T5-6ir76 <br /> TENTATIVI;"APPOINTMENT DATE: lime: 1:30,414 <br /> (Please allow 10 business days from date of application submittal) ` <br /> CHECK BOX TO EXPED FTE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> Unit 1 <br /> 41/ 2. Sucrt <br /> UST 1',1 y, sit 00 O tG� / Unit 2 <br /> u s T L. A. s,.�t 21950 Loo <br /> \+,\4 s'V�A S. sty2913 400"ta1P bor ?oma�t�!N` � Unit 3 <br /> T. street Unit 4 <br /> a. Sired <br /> 9. street Unit` <br /> 10. s rLr Abn L�-AJU L69 A ct <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ONDERGROUND TANK(U51)CLEANUP SPIE(LOP) HOUSING ABATEMENT OLID WASTE..- . <br /> THER CLEANUP SITE(NON-LOP) FOOD FACILITY SOLtO WASTE VEHICLE <br /> fPY'UNDERGROUND TANK(MONITORINGIREMOVAL) Pr-POGKENNEL �DAJRY <br /> AZARDOUS WASTE GENERA70R CHICKEN RANCH KG TREATMENT PLANT <br /> ERED PERMITTED FACILITY �aTEUHOTEL UMPERTRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOIBODYPIERCING OOUSPA !1{tJDUSEAPPLICATIONSFTES <br /> XM EDICAL WASTE FACILITY 0 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 some condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the Baine applicant may require a$93.00 deposit prior to review. <br /> S. TENTATIVE appointment dates must be confirmed with EHQ staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PNONE FAX' 'INITIALS' <br /> REVIEWED YES NO REVIEW DATE <br /> EHD A8-02-005 <br /> 81tir1a41 <br />