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DATE RECEIVED EHD LOG NUMBER <br /> iD) ?"�I� I !I ;- SAN JOAQUIN COUNTY <br /> �i.�9L��i`/ ! ENSqtONMENTAL HEALTH DEPAR'11l NT <br /> 0 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> $E P 12 209)468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd I <br /> ,,-- HO <br /> WNt�IIENT HEALTFI <br /> DFW,>1IT/SER(IV,I/CES PUBLIC RECORDS RELEASE APPLICATIONIr ./ <br /> APPLICANT: (]6�L � ,9 /�n0� C_BUSINESSIAGENCY:�n C' 0/ G�:/ I'"� � tc �410 IAOIif'C <br /> ADDRESS: /P, q �!c<,, ( Ve S r cf r., JT L�_� /� a <br /> PHONE: 'ZOO Z3 1 0--5 "9 FACSIMILE: Z-09 z 3 Lf 0-530 <br /> I .�jt-aa3 <br /> TENTATIVE'APPOINTMENT DATE: \t/i cf IIT �0 Time: <br /> �']�/ (Please allow 10 business days from date of application submittal) <br /> W CHECK BOX TO EXPEDITE REQUEST- 93.00 FEE—REQQUEST PROC SSED:IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��l — ..DATE -'. <br /> Department Use Only <br /> .FILE ADDRESS UNIT <br /> 2-5-75 C <br /> ❑ Unit 1 <br /> :. stied 25.7. C Atr _ a _.. 2 <br /> ]. sVed Z7 0 1 C O <br /> El 2 ,� <br /> 4. a-I �' <br /> city i <br /> s. succi J 3 <br /> 7( 8. SVeel <br /> r. Leel 2 Ccy city. �Unit4 <br /> 9. SVeel 2 ✓ city <br /> 9. SVeel _. - .c .. Unit 5 <br /> 10. S"e! c ity . . .. . <br /> H DEPARTMENT FILES <br /> ENVIRONMENTAL HEALT + r <br /> to �6 � 0 <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP). ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILnY••- <br /> OTHER CLEANUP SITE(NON-LOP) ' <br /> " ❑ FOOD FACILITY -- -"-0-SOLID WASTE VEHICLE- - <br /> 4'UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL_ ❑ DAIRY . <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING - ❑ POOUSPA ❑ 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 reorgad ed 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 /> EH04&42-0 6 - <br /> "ua29a] m.� e .y ✓1 flitrn �( I�'l i..S IS..�0 r. <br />