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OEC-01-03 12:38 FROM-GOLDER ASSO(( +949-583-2770 T-344 P.01/01 F-889 <br /> EHD LOG NUMBER <br /> DATE RC !D SAN JOAQUIN COUNTY <br /> � � ��'� ENVIRONMENTAL HEALTH DEPARTMENT 2 <br /> n 304 E Weber Ave 3rd Floor Stockton, CA 95205 ` 7 <br /> (�0�p4$8-3420 Fax: (209) 464-0138 Web: www.cosan-joaquin.ca.us/chd <br /> ENViRt);VPvi iJ i Hc; LI ftBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ?loser BUSINESSIAGENCY: GD Ij e^ ASS 060-t`,4 11n r <br /> r�1"rs��1� -f <br /> ADDRESS: Ill CiA, 2r r S-bF 6 yV JI�,.2 <br /> PHONE: 94111 5�3-2' 00 FACSIMILE: 9Li'l 583`Z'7� 0 <br /> TENTATIVE"APPOINTMENT DATE: )R a'�C Co-l 1 _Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 3.00 FEE-RED ST PROCESSED IN 3 BUSINESS DAYS <br /> DATE la <br /> SIGNATURE OF APPLICANT <br /> �c /� p 3 <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> ri51 i e �`^ ca ca E] Unit 1 <br /> �� <br /> 2 511Wf OY 1?dVgM Clt <br /> a svee�--tv � o [C o�.no o f e5 C„ Unit 2 <br /> < sreet <br /> cu <br /> c., <br /> 5 S eet <br /> 01 <br /> 6 Street ch <br /> c;, Unit 4 <br /> S:rect <br /> Cn <br /> B. Sueet ElCit Unit 5 <br /> 9 Svaet <br /> Gt <br /> t0 Smeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE.ANN(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK GENERATOR <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> �d HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> /" TIERED PERMITTED FACILITY ❑ PDOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <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 (2091464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant n 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 /> enoae.oc.oec -- <br /> wazom <br />