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Jar.=d J—eUU'4 '1J•11' UUNDUK^'tHK IH ILU.1 �I�y S.S2 .L9yY3. C:F71/p7. <br /> DATE RECEIVED + SAN EHD LOG NUMB <br /> P1,11 (� ,�OAQUIN COUNTY' . <br /> sC�1�tii ENVIRONTYMN'TAL$SALT$DEPARTMNT <br /> ,,(la nn 304 E Weber Ave 3"1 Floor Stockton, CA 95205 <br /> SEP 13 2utT=i�9)468-3420 Fax: (209)464-0138 Web: www.co,saD-joaqujncauS/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: UIE= GENCY: <br /> nICQ 56 /q MCY&ezp <br /> ADDRESS:P[� R�t�i�• �.x r�� �7NnL�.r'f � ' -1---�.-1 <br /> TENTATIVE*APPOINTMENT DATE IG <br /> (Please allow 10 business days from darn of appncatlan submiu20 <br /> `CHECK 13CX TO EXPEDITE RE ST-$93.Do FFE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> sIGNATURE OF APPLICANT ta= DATE / 0 <br /> --T <br /> Departmant Use Only <br /> FILE ADDRESS UNIT <br /> +- sued 4 NA rN� WA 5To - <br /> 2. smv . ,e +Po E] Unit 1 <br /> 313 I r . <br /> a seed I S. Af U2PN y o <br /> Unit 2 <br /> ,. steel z S. y <br /> OA —�' S. s sb w, ✓ -Z 1 <br /> Unit 3 <br /> u co-ed T to 12-7 ILf l LG&O <br /> 7. seefl 1 &1 6 Unit 4 <br /> e. &wt 1 (, -7'11 <br /> e. sed 16 TV cot.oNY aor C] Unit 5 <br /> +a. sued <br /> ISIC <br /> SANros A rPoJv r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ` <br /> )91 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENTS SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY LL99 SOLID WASTE VEHICLE <br /> $I UNDERGROUND TANK(MONITORiNGREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> �6 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> -TiEREb PERMITTED FACILITY ❑ MOTELmiOTEL C1 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOOISODY PIERCING ❑ PDOLISPA 9,LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1, List up to ten addresses in the spade above. Select the type(s)of flies from the list aboye by Checkin <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 Fie that is actively being worked on by CND staff may not be immediately available for review. A ne <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 expend <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie <br /> 5. 'TENTATIVE appointment dates must be confirmed with FHD staff_ <br /> 6. 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 L NO / REVIEW DATE r <br /> -JV Vy • II �� h- PQ 1 S IE'f Ae,- G P26i44; 3/'IPS )(eVKTOTRL P.O: <br /> cGtil 0(1-h-e ✓l- e eOt r l- d�5J M,1qe0 ba 5 o kt r)C <br /> ivFS <br /> J. �.Lw�,l t q 0",,-(5 tb <br />