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DATE RECEIVED <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />4 <br />304 E Weber Ave 3Td Floor Stockton, CA 95205 <br />468-3420 Fax: (209)'464-0138 Web: Vr'VVW.co.san-joaquin.ca.us/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS:re <br />BUSINESSlAM�NCY:-Ic�s� <br />C4 <br />Z;✓ p -x <br />PHONE: i„ �0z8yo-"-Q —( --n ACSIMILE:T� <br />TENTATIVE` APPOINTMENT DATE: ����t�–C Time: <br />EHD LOG NUMBER <br />Z� <br />LUEST <br />se allow 10 busine s days from ate of application submittal) <br />in CHECK BOX TO EXPEDITE RE - UEST P ESS D IAIBUSINESS DAYS <br />SIGNATURE OF APPLICANT J DATE <br />/ Department Use Only <br />I7 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />❑ HOUSING ABATEMENT <br />FILE ADDRESS <br />❑ Unit 2 <br />17 <br />Unit <br />, <br />z_ <br />Sit <br />�i✓ 233 - /3o Z <br />ci. <br />4. <br />Sheet <br />o 72Yc - <br />G <br />5. <br />6. <br />Sheet <br />street <br />��- + <br />Z <br />G TY <br />OZ C <br />i. <br />Street <br />G <br />8. <br />Street <br />� <br />/CrJ� <br />9. <br />Sweet <br />Q <br />10. <br />Str <br />I7 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />❑ HOUSING ABATEMENT <br />❑ Unit 1 <br />❑ Unit 2 <br />17 <br />Unit <br />, <br />Unit 4 <br />❑ <br />❑ Unit 5. <br />❑DAIRY <br />❑ PKG TREATMENT PLANT <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />17 <br />FOOD FACILITY <br />0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ <br />DOG KENNEL <br />❑DAIRY <br />❑ PKG TREATMENT PLANT <br />0 HAZARDOUS WASTE GENERATOR <br />M <br />❑ <br />CHICKEN RANCH <br />MOTELIHOTEL <br />D PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TIERED PERMITTED FACILITY <br />13 <br />POOLISPA <br />0 LAND USE APPLICATION SITES <br />El TATTO013ODY PIERCING <br />❑ MEDICAL WASTE FACILITY <br />❑ <br />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 matt to the <br />address indicated above: <br />2. EHD will notify the applicant if any EHD files exist. Ars 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 />F 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 />CO,PlFIRMED APP.DIIV''MENT DATE ;:.. :. TIME . <br />PH <br />DATE COI�IFIRMED ;> ONE FAX <br />INI1 IALS <br />REVIEWED YES NO REVIEW DATE <br />EHD 48-02-004 , <br />S 2ao3 <br />