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DATE RECEIVED' LHU LUti N> Mdr-K <br /> SAN JOAQUIi.N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 9245 <br /> Q09)468-3420 Fax: (209)464-0138 We_b: www.co.san joaquin.caLus/ehd <br /> .. <br /> F PUBLIC RECORDS RELEASE APPLICATION <br /> SG�=LJcrea� eo +Uitni�1 ? L <br /> APPLICANT: tcr-' <br /> (B'USINES,S1►AGENCY. <br /> ADDRESS � <br /> PHONE O�D 1• '7 /• ( Q(J flJ - FACSIMILE <br /> V. <br /> TENTATIVE`APPOINTMENT DATE: <br /> (Please allow 10 business days from dat0 of appllaatlan submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS ' <br /> SIGNATURE OF AI�PE•[CANT ` -^�' -- - DATE <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> �. E] - <br /> Unit 1 <br /> ,. svod <br /> 7 svw " ut <br /> a <br /> Unit 2 <br /> 7, SUeet - � .A <br /> 4. 3traet [,� <br /> ct+ Unit 3 <br /> CIO <br /> ci <br /> ®. sttaotUnit <br /> G <br /> 7. Street O <br /> Gt <br /> e. sveat Unit 5 w <br /> a ❑ . <br /> 9, Sir»c+ <br /> CI n <br /> 16. 51rea[ - <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d HOUSING ABATEhAENT R SOLID WASTE FACILITY 0� <br /> UNDERGROUND TANK(UST)CLEAT IUP 517E(LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEAN0P SITE(NON-LOP) 0 DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCKNARnICHEM TOILETS <br /> ❑ TIERED PERMITTEDFACILITY 0 POO11SPA ❑ LAND USE.APPLICATION SITES <br /> � TATTOOIBODY PIERCING • ❑ OTHER(PLEASE SPECIFY) <br /> CI -MEDICAL WASTE FACILITY <br /> e s of files from the list above by checking <br /> {, List UP to ten addresses in the $pace alcove. Select the typ { } <br /> the appropriate box(es): At least one file type MUST be selected. Fax to 209 464-0138or mall 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 sslatdays <br /> for revien ten w. Appointmays after ents shouleipt of d scheduledion, The fles <br /> will be held for a maximum of five business day <br /> accordingly <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file riot return®d in the same condition as same apped will be reorganized by EHD staff.at the expense <br /> licant licant may require$93.0 deposit prio to evi w. <br /> of the applicant. Future file reviews by Pp <br /> 5, 'TENTAT}NE appointment dates must be confirmed with EHD staff. <br /> b. Applications received after 3:00 pmwill be processed the next business day' <br /> CONFIRMED APPOINTMENT DATE. <br /> TIME <br /> DATE CONFIRMED . <br /> PI•IQNI~ FAX INIT S _ <br /> REVIEWED <br /> YES No REVIEW DATE <br /> e»n 16-0zaod <br /> W40ns <br /> 10/10 30Vd NO171001S 39tt 8TZT19b60Z 01:ZT £007-/81/80 <br />