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- EHO LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> �D <br /> DAnECjMVLPJJl)4ENT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 L <br /> 1410 <br /> ULU 2 1 20Q509) 468-3420 Fax: (209)464-0138 Web: www,co,san-jaaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> •c6 �� rJ BUSINESSIAGENCY: Iy'e` (Uv�2rSy✓•� r „SSG/p��-s - <br /> APPLICANY;-S,�'M � 1 t •� - s � l ,/� <br /> ADDRESS; c'n U-7 -3701 <br /> Tt�L/s_rr i, v"�� 4-vU L!" ' <br /> PHONE; d-o l • <br /> TENTATIVE"APPOINTMENT DAT .e', ��'•.o, me: I ���� <br /> (Please allow 10 business days from date of appticatlon submittal) <br /> ' CHECK BOX TO EXPEOITE RE UST•$93.0 EE-REQUEST PROCESSED IN 3 BUSINESS DAYS � 1 <br /> SIGNATURE OF APPLICANT DATE <br /> Y <br /> Department Use Only <br /> UNIT <br /> FILEADDR°SS <br /> street w e5 S Lt.rA,, e at 5 e C ❑ Unit 1 n�(� <br /> z. rn 70 W WA er ut r o <br /> s saa-t ElUnit 2 <br /> 4. en -fv `C- L£v�R at Svc i1•'-J M 'rn`' \:J <br /> S, siren �N R tr ( ^ 11 Ca S t oe d Unit 3 <br /> e. seeet // Wes'T 1�C.�(o'4�_I'ESI_ . en 1 ee / <br /> 7. street .7 L3 ,I Q [� cit W Unit d <br /> a. street Sd Lt..�l„+� c G� Vre+""51<IJ G S1�C .J <br /> �� C„ ❑ Unit 5 <br /> s <br /> 1a. an--eet— <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Srrr(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ® OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> IA UNDERGROUND TANK(MONITORINGIRFMOvAL) U DOG KENNEL O DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 HAZARDOUSWASTE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEMTOILETS <br /> TIERED PERMITTED FACILITY ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> Q TATYOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILrfY <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 /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. 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<e•aZ-0c4 <br /> a10Y1�a5 <br />