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08/09/1007 `l'HU 15:05 FAX 2094682999 SJC PUBLIC WORKS X004/006 <br /> _ OATF•RECEIVEDSANiT Y [HD LOG NUMBER <br /> I+JNVTRONM)ENTAL HEALTFF DEPARI'ME <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> y(209)468-3420 Fax:(209)464-0138 Web.www.co_san joaquin.611 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Claudia Gembexling BUSINESS/AGENCY: San Joaquin County Public Works Department <br /> ADDRESS_ 1810 e. Hazelton Avenue, Stockton, California 95205 - <br /> PHONE: 953-7624 FACSIMILE: 468-2999 <br /> TENTATIVE"APPOINTMENT DATE. Time: <br /> (Please allow 10 business days tram date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUES •$93.00 FEE-•REQUEST PROCESSED IN 3 BUSINESS DAYS ��v <br /> SIGNATURE OF APPLICANT li(.ty—ck c [LATE <br /> Department Uso Only <br /> FILE ADDRESS UNIT i <br /> ,. stmt i h• W S �d31 e� © Unit 1 - <br /> �. sum, <br /> r,t <br /> 4. sucet 12170 e.ty ( Unit 2 <br /> s. sueel 0 / 0\ <br /> Unit 3 <br /> 7. sv et aty <br /> Unit 4 <br /> 9. sa°`t p Q aty ❑ Unit 5 <br /> to. succ, O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )9C UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ADATEMENT SdUD WASTE FACT <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY SOLID WASTE VEHICLE �+ <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL DAIRY J <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH PKG TREATMENT PLANT 0 — <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL I PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOIBODY PIERCING ❑ POOMPA 13 LAND USE APPLICATION SITES <br /> t5 MEDICAL WASTE FACILITY 0 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 snail 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 o <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A nevi <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 /> ..........:.. <br /> - --- <br /> DATE,a( NFIFZM> D:: <br /> .9ffff �INiTrA <br /> R .., 040 <br /> EHD 4842406 <br /> srarzaos <br /> FILE COPY <br />