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UAJ Hj-.QE1VED <br /> I t- - 0 • EHD LOG NUMBERI Lj)iL_I SAN JOAQUIN COUNTY <br /> I'ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avc 3"1 Floor Stockton, CA 95205 el^ <br /> (2,0,9)1468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin <br /> ca.us/ebd <br /> PC <br /> PU13LIC RECORDS RELEASE APPLICATJON <br /> APPLICANT: W BUSINESSIAGENCY: 0, A <br /> ADDRESS: 0-2— <br /> PHONE:--,36 FACSIMILE: �7 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 3.a0 -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> -7 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 2-jL /K(JV4+A;^ f4vVoE afy <br /> Z SIM,! Unit 1 <br /> 4. Street CIN ❑ Unit2 <br /> 51 slreN aly <br /> Unit 3 <br /> Unit <br /> 7. s MI CIUnit4 <br /> 0. Street hy Unit <br /> 9. stre:( cUnit 5 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT E3 SOLID WASTE FAC I SH <br /> OTHER CLEANUP SITE(NOWILOP) n FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONFTORINGIREMOVAL) n DOG KENNEL CI DAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIHOTF4 In PUMPER TRUCKIYARDICHEM TOILETS <br /> El TATTOOIBODY PIERCING tJ FOOLISPA M LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIFY) <br /> I List up to ten addresses in the space above. Select the type($) 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 /> S. *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 /> -fHe-4442-00G <br /> verz003 <br />