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ATE MWED <br /> SAN JOAQUINCOUNTY <br /> Fop���N�MSER <br /> ENVIRONMENTAL 11EALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> )468-3420 Fax: (209)464-0138 Web:www:co.san-joagnin.ca.usl&, <br /> ENVIRONMENT HEALTH <br /> -PFBWI�GEUICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �0e. 1C&SC( y--e- BUSINESSIAGENCY: v 'Iadr,sf Ze-4 <br /> ADDRESS:'_l'I} I /VY„�r� ��• -- 5 C., n_. +4 - -cl 53 z!,p <br /> PHONE: �2oa 7 3 `t FACSIMILE- <br /> TENTATIVE*APPOINTMENT PATE: I . o,O s Time: <br /> (7. ' <br /> (Please allow 10 business days from data of application submttW) <br /> r <br /> 13 GMECK BOX TQ EXPEorrE REQUEST-$93.00 FEE-REQUEST PROCESSED!IN 3 BUSINESS DAYS / c-} <br /> SIGNATURE OF APPLICANT DATE I�15+Ja� <br /> Dapartrmnt Use Only <br /> ! FILE A1]ORESS UNIT l <br /> ,. Shoot 1'101 wrerw+t 5}. Unit <br /> t <br /> 2 st" <br /> svFeat l7 Unit 2 <br /> c Cdy �► <br /> 6. $treat . <br /> r. sweet �Unit4 <br /> a swat <br /> e. sneer <br /> city Unit 5 <br /> ti0S��ax 4 <br /> ;i <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(U,5T)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Ok SOLID WASTE FACILITY <br /> qL OTHER CLEANUP SITE(NON-LOP) 0 FOOD FAPIL Y ❑ SOUD wAsTE VEHICLE <br /> UNDERGROUND TANK(MIONITORINGIRENIOVAL) 0 DOG KENNEL 0 DAIRY <br /> )-&HAZARppUS WASTE GENERATOR 0 CIJICKEN RANCH 0 PKG TREATMeNT PLANT <br /> +[$7m <br /> TIERED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARnICHEM1 TOILETS <br /> TATTOQlBODY PIERCING 0 POOLISPA A NV USE APPLICATION SITES i <br /> INMCAL WASTE FACILITY OTHER(PLEASE SPECIFY) W#11 Q +��- -- 1 <br /> 1. List up to ten addresses in the space above, @el et the typiele(s)of files Fax toro t e list above <br /> by ChL <br /> mail to the <br /> C <br /> i the appropriate box(es). At least one file type <br /> +address Indlcated above. III be <br /> 2. EHD will notify the applicant if any EHD files exist+ An dO p i tm nt afteoraceipt f application. he files <br /> approximately five business days but no later than ten(; 0) y <br /> will be held for a maxlmum 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 maynot 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 /> C, Applications received after 3:00 pin will be processed the next business day. <br /> :3 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONE FAX INITIALS. <br /> REVIEWED YES NO REVIEW DATE ` <br /> ptro�aaz.00e f <br /> elar2oo� - <br /> ststileud o.taZ punoa0 <br /> Td Wdbc;C0 SOOZ t7T 'Uel 2886 8£8 60Z 'ON 3NOHd <br /> E� <br />