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NEIL ANDERSON EWP� O PAGE 03/0 12/23/2000 12:26 209369 EHD LOG NUN z DATE RECEIVED SAN JOAQUIN COUNTY ENvIRONMFNTAL HEALTH DEPARTMENT 304 F Weber Ave 3rd Floor Stockton, CA 95205 I�� iIEC 2 3 ?_004 (209) 468-3420 Fax: (209)464-0138 Web- www.eo.san-joaquin.ca.us1ehd PUBLIC RECORDS RELEASE APPLICATION = Nit o Amou4c� t ADDRESS: r f D BUSINESSIAGENGY: APPLICANT: >n – , — PHONE: �� –3� \ KACSIMILE: 3LoGl '-EZ TENTATIVE*APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal) 04) 4 4 f CHECK BOX TO EXPEDITE REOUEST.$9/3.00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS 23 D SIGNATURE OF APPLICANT �i��/�'—� DATE 12- Oeortment Use Only FILE ADDRESS UNIT MStr�t . • 33 al 1 �rtiL ❑ Unit 1 2. streell S ON G ✓q ❑ Unit 2 y ( C'1 cl Unit 3 5. slmd ci 7. Saeel el Unit 4 e, 5i t OI 5. street city O Unit 5 10. Sime CII ENVIRONMENTAL HEALTH DEPARTMENT FILES T� UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY ^$�q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ 50LID WASTE VEHICLE UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY 19 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 4 PKG TREATMENT PLANT I TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILE ❑ TATTOOIBODY PIERCING ❑ POOLISPA 0 LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIm — 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by check the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to tf address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The fit will be held for a maximum of five business days for review_ Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD Staff may not be immediately available for review. A; I application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expe of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to rev I. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE RHO 464;4ec ._ wa2oa]