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DATE RECEIVED <br /> SAN iOAQM CO);JNW EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:wWw.cO.sanjoaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: David Ty BUS)NESs/AGENCY: TTn1nn Rpfp TIPDopit Renk <br /> ADDRESS:. 517 F. Weber. Street Stockton r'A Qs?n2 <br /> PHONE: 209-946-5230 20Q_4F1-414 y��— C/77 <br /> FACSIMILE:_ T <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of apPOCOtion submittal) <br /> f7 CHECK BOX TO EXPEDITE REQUEST-$e FEE-REQUEST PkOCESSED IN 3 BUSINESS DAYS J <br /> SIGNATURE OF APPLICANT DATEale <br /> pettment Use only <br /> FILE ADDRESS UNIT <br /> ,. 6eea <br /> CRY <br /> 2 Sbaet ❑ Unit 1 <br /> 9. 61reet <br /> 4. Seeet tl ❑ Unit 2 <br /> 6. se <br /> s Street c Unit 3 <br /> Oty <br /> T. <br /> 6. so.m _ caV Unit J4 ,❑ Unit <br /> o. seen c <br /> ly <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) C] HOUSING ABATEMENT 11SOLID WASTE FACILITY <br /> / OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY Cl SOLID WASTE VEHICLE _. <br /> V UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> Cl TATTOO/BODY PIERCING ❑ POOL/SPA 0 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 /> 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 APPOINTMENTT TIME <br /> DATE CONFIRMEDPHONE FAX. INITIALS <br /> REVIEWED Y-S NO REVIEW DATE <br /> ZOOS) ` SNVO'I saff IIts Hasa tLLt C9D hoz %Vd zC:OT t00z/9z/T0 <br />