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SANJOAQUIN COUNTY <br /> �i S"NW <br /> , HEALTH DEPAF SENT <br /> � I IRONMENTAL 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> MAY 2 8 ( p9)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONKIIE;4 i PUBLIC RECORDS RELEASE APPLICATION <br /> ,oi. <br /> APPLICANT: �i ,m // BUSINESSIAGENCY: � <br /> /f'Ac� <br /> ADDRESS: �3'�/7 �YjG((i°�IL�Gq/ C�IIrLI+e - I� AJ (4 <br /> PHONE: )9 5L2;3M� ✓��(��T�(l� FACSIMILE: <br /> �ecc L <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> �} (Please allow 10 business days from date of application submittal) <br /> 4� CHECK BOX TO EXPEDITE REQ UE -$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Qom-- DATE <br /> v <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. street s Y .4ve_Alke Dy 7<S _ 53-//Tt) - g53 C- <br /> " _ ❑ Unit 1 <br /> 2. Street G ,� 25, �� � ✓vtl�C Ci <br /> 3. Street aty Unit 2 <br /> 4. Street CRYi <br /> S. Street aty Unit 3i!! <br /> 6. Street G <br /> 7. Street G Unit <br /> 8. Street oty <br /> 9. Street a ❑ Unit 5 <br /> 10. Street G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT X SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> $C HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> X.TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOBODY PIERCING ❑ POOLISPA ❑ LAND USE�APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) N"{ <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 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 reorganizedbEk se <br /> �7 <br /> of the applicant. Future file reviews by the same applicant may require a$93:-0() a os r ;iew <br /> . <br /> 5. - 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6, Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE - TIME z <br /> DATE CONFIRMED, _ :` _PHONE. FAX - - -NITIAL$ <br /> REVIEWED YES NO REVIEW DATE <br /> EH0 48-02-006 <br /> W=003 .- . <br />