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.i <br /> DATE RECEIVED � EHD LOG NUMBER <br /> SAN JOAQLTIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> 468-3420 Fax: (209)464-0138 Web: vvww.co.san joaquin.ca.uslehdZI qZ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> M /r <br /> APPLICANT: ���/�� /�f (BUSINESS/A <br /> ADDRESS: �� S. '�S�FYI G. J l ��L� S'� C4 ���1?9 <br /> PHONE: O �D""D �� ACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: � ����'��� Time: j <br /> lease allow 1d buslne jdaysfrom ate of a lication submittal(PPP� ) <br /> CHECK BOX TO EXPEDITE RE VEST- BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �`1 <br /> Department Use Only <br /> 4 <br /> :I FILE ADDRESS UNIT I <br /> 6.3 — aty ' - ? ' I� ❑ Unit 1 <br /> z_ S 'o 2 3-130 2 a yA <br /> E !�P ''a.c�� G aGl a' <br /> s. sem► ❑ Unit 2 <br /> strZZ- ,o G �4 <br /> s. street. mac. o Unit <br /> _z <br /> i. 6. strell oty <br /> ,. Street o Unit 4 <br /> i a. street <br /> o� <br /> E <br /> s. Street C - a El Unit 5 <br /> G <br /> tyi <br /> ENVIRONMENTAL HEALTH.DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Cl OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 11CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ MOTELIHOTEL El PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY Cl POOLtSPA ❑ LAND USE APPLICATION SITES <br /> 17 MEDICALTATTOOt1WAS PIERCING ❑ OTHER PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY ( <br /> 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 /> i 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. AP ENT DATE TIME <br /> DATE COIIFIRMED . AHONE = FAX iNlT.IALS <br /> -REVIEWEDYES NO REVIEW DATE <br /> 81=001 - <br />