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- <br /> DATE A E V E DU SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> Ei NV MONMENTAL HEALTH DEPARTMENT I <br /> FEB 0 9 9005 304 E Weber Ave 3fd Floor Stockton, CA 95205 <br /> (ON <br /> tr1g C1t 20 Fax: (209) 464-0138 Web: www•CO.san Joaquin.ca uslehd <br /> ENVIRONML <br /> PEPWIT..SERVICE1S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: U R: n C (• S <br /> ADPKESS: , o ' A�V\ S-'T J <br /> FACSIMILE: 1 <br /> y� �jo0J)\ . TIM: 15_..�P dq .`t'ItI <br /> C TENTATIVE' APPOINTMEKT DATE: , �— \J� ; <br /> (Pinaas allow 10 6ualneas days from data of oppilaallon aabmittal) <br /> CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE " REQUEST PROGESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT a DATE <br /> Dedadment Use Only <br /> UNI <br /> FILE ADDRESS <br /> "10 ( v } a Stocki [] Unit1 <br /> z. creel ._ C <br /> a � p Unit 2 _ 1111 <br /> a. suaal a 000< 3 <br /> e. sv.a a <br /> a �UI1$ a <br /> e. somal a <br /> ❑ Unit 5 <br /> 9. Slroet <br /> ta. 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) n HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE INON-LOP) 0 FOOD FACILITY C7 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) 13 DOOKENNEL 0 DAIRY <br /> HAZARDOUS WASTR GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 11TIERED PERMITTED FACILITY ❑ MOTEUNOTEL O PUMPER TRUCKIVARDICHEM TOILETS <br /> O TATT001e0DY PIERCING El POOLlSPA LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY <br /> 1 . List up to ben addresses In the apace above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 484,013j.2LrrtaiItRjLe <br /> iIldicated Phove. <br /> 2 EHD will notify the applicant If any EMD files exist. An appointment for review will be confinned <br /> approximately five business days but no later than ten (10) days atter 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 condttion 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 /> 6. *TENTATIVEappointment 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 /> REVIEW DATE <br /> REVIEWED YES NO <br /> EH 5-000 <br /> I <br />