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EHD LOG NUMBER <br /> L,l SAN JOAQUIN COUNTY . <br /> p g 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 304 E Weber Ave 3ra Floor Stockton, CA 95205 <br /> Efd\11RONfvlEfdl( 49 T68-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca-us <br /> /chd 00.5/ <br /> PUBLIC) RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSIN/ESSIA-G_ENCY: �C( � �-"� ��y 5�✓.�_ <br /> ADDRESS:( -7 `'E 3 !�' Gql f Cgli9� <br /> PHONE: \ 1 'r ( —QU` FACSIMILE: `r ( -'2'0 l Q 2-0 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) ZL <br /> 10 CHECK BOX TO EXPEDITE REQUEST-$93,000/FEE-REQUEST PROCESSED IN-3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /3�'�/� DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> Z/V 1. Street ^ S6 i• G L UST (oo ,ItZIDCs <br /> 2. Street 3 I i S_ e,� 5 cc�/a...�t;., G a tF00a Unit 1 <br /> 3. sveet L /C `C G L r`ayF ❑ Unit 2 a <br /> 4. Streel 1� (` 1 C I( Ci �—�'� ( NF 1 <br /> (� 5. street 3//33 `( r ` /C a ✓ -{ Pn6. Street b Kv _ �•c.-(: Cir. street G <br /> 8. Street C <br /> 9. SUeel G E] Unit 5 <br /> 10. SVeel CityE <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ 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 APPOINTMENT DATE ;:, =TIME <br /> DATE CONFIRMED PHONE FAX INITIALS', <br /> REVIEWED YES NO REVIEW DATE <br /> EMD 4842-006 - <br /> 6182003 <br />