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JAN J OAQUIN COUNTY <br /> F�RONMENTAL HEALTH DEPARENT <br /> T04 E Weber Ave 3`d Floor Stockton, CA 9D205 <br /> 09) 468-3420 Fax: (209)464-0138 Wb <br /> 5 Z1e : www.co.san joaqui / <br /> n.ca.usehd <br /> APR 1 7 <br /> =i i HEHLTH <br /> PUBLIC RECORDS RELEASEE A-P(PLICA<TION p <br /> APPLICANT S+-Pse C�ct-P-tr'4' BUSINESS/AGE/NCY: /fVy(.f�w5 CIII V'dV(l�� A <br /> ADDRESS: 33, /� �/r.[neF^CYI L6ky✓L iy2R Sc-✓fie ,�j',�D �'11by,P.(/rm�l 1�ui1,12� ('A 4s-0--. <br /> PHONE: Sj0 66'rvvGG FACSIMILE: S3 OCJ 7 - <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEES—REQPESTPROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 7 �/, ( / DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> . / ❑ Unit 1 In I-- <br /> 2 suc : ! ma �-TCUnit 2 <br /> 4. So- yl F i- vtA e S �^eF (ae l- <br /> s <br /> 6. Unit 3 <br /> �3j yr1� <br /> ,. 310 e , Miley Si. r1 /e <br /> Unit 4 <br /> 8. Street 2- !i✓ CAY / <br /> 9. strew j U t't , / SE- 1//774 A ❑ Unit <br /> 10. str <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 17 <br /> L I_ r- <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILr> <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOlBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 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 /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. @ <br /> 6. Applications received after 3:00 pm will be processed the next business daf:F) t=" <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Eno 48a24oc <br /> uerzao� <br />