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EHD LOG NUMBER <br /> ATE RECEIVED tom. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> AUG 1 3 20W9) 468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin.ca.us/chd <br /> ENVIRONMENT HEALTH 1PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KIK,AN / pr("A'wo BUSINESS/, J AGG•ENCY: SIP.Pr7V5 6N�//ll(ONMENTAL, LNG <br /> ADDRESS: 3330 U)rnef-or-i ?49-IL 'b f-, 'r5.50 CAtf-�C"N C'A flSb82- <br /> PHONE: 530 641- 600 -4 FACSIMILE: 530 4�6 600s <br /> TENTATIVE*APPOINTMENT DATE: £113 Io (+ Time: a., 00 hid <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$r FEE-REQUEST <br /> �PPR�OCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT " /1 JK DATE 10811.310(P <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 717o�KOVNIy CLqb I % uYZ svet 7 Se2(O ❑ Unit 1 <br /> 2 Veet �J a'� �,t G •I M .5 - <br /> a. sveet 2�Sz. „ G ti a��" Z ❑ Unit 3 � <br /> 1t12 4. Street LSos a <br /> s. SVeet aty Unit 3 <br /> 6. Street r" <br /> 7. SVeet city I <br /> e. Street �' <br /> 9. Street Ci ❑ Unit 5 <br /> 10. SVeel <br /> ow <br /> JX <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �I <br /> p UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Cl DOG KENNEL ❑ DAIRY <br /> /29 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM 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. <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 /> EHD 48-02-006 <br /> 8M001 <br />