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DATE RECEIVED SAN JOAQUIN COUNTY' <br /> t <br /> ENVW <br /> OMUNTAL HFALTH DEPART <br /> 304 E Weber,Ave P Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-01.38 Web:www.co.ssalx joaquin,ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> L A 8Ug1NESSIAGENCY: LL F' <br /> APPLICANT: <br /> �-� FlL r <br /> L ADDRESS: .�/..S I � 1 -� <br /> PHONE: 2— FACSIMILE: <br /> TENTATIVE-APPOINTMENT DATE: rime: <br /> (Please allow 10 bUsi ess days ftr"date of 2PPlleatlon submitLil) <br /> In CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 MSINESS DAYS D <br /> [TATE <br /> ASIONATURE OF APPi-iCANT y p aeDarb-mnt Use only <br /> 7Unit <br /> FILE ADDRESS <br /> } r[]1. >� L72. S" <br /> 4 �t p Unit 3 <br /> a p Unit 4 <br /> T. <br /> a p Unit 5 <br /> 9. &f�K <br /> 1c ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> t3 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEOUP SITE(LOP) D FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 0 OTHER CLEANUP SITE(NON4.OP) D DOG KENNEL 0 DAIRY <br /> 13 UMEROROUND TANK(MONITORINC+�EMOVAL) D CHICKEN RANCH ❑ PKG ER TRMENTUCYJ APW"1�9M TOILETS <br /> ye p HAXARIMS WASTE GENERATOR D MOTEUMOTEL D PUMPER TR��'ARD <br /> C1 TIERED PERmMID FACILITY O POOLIBPA <br /> D TATTOOMODY PIERCING 0 OTHER(PLEASE SPECIFY) <br /> 13 #AED1CAL WASTE FACILITY f alts a by A no <br /> List up to ten addresses in the space above. Soled the types)ofto(201 <br /> theappropriate box(es). At least one file"MUST be selected. F <br /> *0d-4 s lndlaated abo ;ntment for review wlll be confirmed <br /> 2• EHD will notify the applicant If any EHD files e1�s'-An�ppo aye a receipt of application- The flies <br /> approximately five business days but no later Appointments should be scheduled <br /> will be held for a maximum of five business days for rereview.W.le fflimmediately available for,roview. Anew <br /> accordingly.ugly' EHD Stan may not be imrn Y <br /> 3. A file at is actively being Worked on by <br /> applicatian may be submitted when the file is available. be airs a X9 y E D eta f prior to pens ►. <br /> M file not returned in the same condition as�eei applicant may require anized by END staff at the expense <br /> 4. y <br /> of the applicant. ointme tfile <br /> dates�s be confirmed with EHD staff• <br /> g, +�TENTATNE app <br /> Applications received after 3;00 pm will be processed the next business day. <br /> 8. <br /> TIME <br /> CONFIRMED APPOINTMENT DATE INITIALS <br /> PHONE FAX <br /> DATE CONFIRMED RIMEW DATE _{`r <br /> REVIEWED YES NO <br /> .,r.at.00t <br /> �rteos <br />