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6ATE`REt:FIVLD ... SA1v JOAQUZN COUNTY U I —� L1 U 0) ENVZR01`MENTAJ, WAL.THDEPARTMENT 304 E Weber Ave 3ra Floor Stockton, CA 95205 SPR i. 7 4006 (209) 463.3420 Fax: (209) 464-0138 Web: vrvnv,ro.saii-joa,,quiii.ca.us/ehd ENVIRONT1 F EBVICES .._ i HEALTH PERh41ILPUBLIC RECORDS RELEASE APPLICATION S - APPLICANT: ADDRESS: `10Z Z BUSINESSIAGENCY: PHONE: j2N UID ':J%O f FACSIMILE:e7 3t 22 — TENTATIVE` APPOINTMENT DATE: Ra_LA 04–CWTime: (Please allow 10 business days trom date of application submittal) El CHECK BOX To EXPEDITE REQUEST -$93.00 FEE– REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE �Z OF APPLICANT �� A DATE �,^U^(0 Department Use Only ENVIRONMENTAL HEALTH DEPARTMENT FILES UNIT F ❑ Unit 1 Q Unit Unit 3 Unit ❑ Unit 5 r/UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY d OTHER CLEANUP SITE (NON -LOP) Cl FOOD FACILITY ❑ SOLID WASTE VEHICLE 1�//UNDERGROUND TANK (MON rrORINGIREM OVAL) 11 DOG KENNEL 13 DAIRY f; AZARo0U5 WASTE GENERATOR d CHICKEN RANCH ❑ PKG TREATMENT PLANT C� TIERED PERMrrTED FACILITY O MOTELRiOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS ❑ TATTOOf600Y PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the types) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 209)464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3, •A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4- Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS - oKvlrwFm YES NO REVIEW PATE I:HP 4E.02-0 6 rvano0a FILE ADDRESS S4ce1 114 1 1 1. 2. SIrCH city Q aRR6eK- 1(Jv ]. uM Cl C •-/` r Mar; oaSct cty sic-�✓� 5. herd M 6, Slreel 4A T. Frra Utv B. Servet Gfv a, Street C11 fv. street CI ENVIRONMENTAL HEALTH DEPARTMENT FILES UNIT F ❑ Unit 1 Q Unit Unit 3 Unit ❑ Unit 5 r/UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY d OTHER CLEANUP SITE (NON -LOP) Cl FOOD FACILITY ❑ SOLID WASTE VEHICLE 1�//UNDERGROUND TANK (MON rrORINGIREM OVAL) 11 DOG KENNEL 13 DAIRY f; AZARo0U5 WASTE GENERATOR d CHICKEN RANCH ❑ PKG TREATMENT PLANT C� TIERED PERMrrTED FACILITY O MOTELRiOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS ❑ TATTOOf600Y PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the types) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 209)464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3, •A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4- Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS - oKvlrwFm YES NO REVIEW PATE I:HP 4E.02-0 6 rvano0a