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VHIC KCt.CIV CU <br /> SAN JOAQUIN COUNTY <br /> EN..,WNMENTAL HEALTH DEPARTIrwwNT <br /> 304 E Weber Ave P Floor Stockton,CA 95205 <br /> (209)468-3420,Fax: (209) 464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION I <br /> APPLICANT: SWq�IQ-9✓) ,1 4 �-' ' '� BUSINESS/AGENCY: <br /> ADDRESS: �// rl"/ P ue C�' C r �C.�6 Li dd/'I9n/ e- <br /> PHONE: �ZS ' � III0 FACSIMILE: . <br /> TENTATIVE'APPOINTMENT DATE: Tune: <br /> (Please allow 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$9 �^ EE—REQUEST PRO ESSED IN 3 BUSINESS DAYS <br /> c � <br /> SIGNATURE OF APPLICANT %/i �Arn l ( DATE 32- <br /> 1 <br /> Deparbnent the Only <br /> FILE ADDRESS UNIT <br /> 351r, ,. Sl 5 s C o u 7 r2 C c n<ro J <br /> a95o t 7.0.--� sYti [I unit 1 <br /> 1. S <br /> 3. 54ed <br /> ❑ Unit 2 (A' <br /> 4. sow CRY <br /> S. So- a tUnct4 <br /> G. S4 <br /> City <br /> r. 50 <br /> s. sweet CKY <br /> S. sheet City Unit S <br /> 10. SU <br /> CKY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 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(MONRORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING D POOLfSPA D 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 APPOINTMENTDATE TIME z <br /> DATE CONFIRMED `+PHONE FAX ANI <br /> T(ALS <br /> REVIEWED YES NO REVIEW DATE = <br /> EHD M-01906 <br /> �1 <br />