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EHD LOG NUMBER <br /> E RECEIVED — SAN JOAQUIN COUNTY <br /> 0 ENVIRONMENTAL HEALTH DEPARTMENT <br /> AECE11WE D� 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> AUG 13 20fp9) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd 1 <br /> 1 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> / N�(n.A P„F{�l) BUSINESSIAGENCY: STeR'TVS E1`1Jt>LONMEN1AL S.av L' <br /> APPLICANT: 2 .p l`f�EU� �A.eX � %S68 Z <br /> ADDRESS: 3330 cArac -o r) ra'n'k ��, 'SSO 1 <br /> PHONE: 530 6.;I'b 600 -4 FACSIMILE: S30 6"16 6005 - <br /> B�I� 10 Time: CS:00 �^6 <br /> TENTATIVE APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$ FEE- QUEST PROCESSED IN 3 BUSINESS DAYS <br /> 4�„ N4� � DATE <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> t. street 2q 2S' GOVN1Ly CLIP. IAf F- ei STOf-Kt�Ory ❑ Unit <br /> 51,P2 1 ✓ 1704 <br /> 5r <br /> 5a.5 -^tt z. Street 2-0 z- <br /> „ a�� j <br /> eet .�. G E] Unit 2 <br /> 3. str <br /> ( <br /> 7''fIZ 4. Street SOS G <br /> 5. Streel ON Unl <br /> 6. street Q <br /> r sveet e; � Unit 4 <br /> Ci <br /> a. Street <br /> 9. street 0 ❑ Unit 5 <br /> 10. Street Q <br /> �[ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) <br /> El FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK ORINGIREMOVAL) 13 DOG KENNEL [73 DAIRY <br /> H <br /> HAZARDOUS WASTE GENERATOR <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> OTIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ 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. 041 <br /> 6. Applications received after 3:00 pm will be processed the next business day. RU ftd <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> e/eaooizoos r�-17 04: FI2 a�2S lourMf� _HZO �l�Ji✓ t L�C/z <br />