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DATE RECEIVED EHD LOG NUMBI-H <br /> InFnnI� (� L SAN JOAQUIN COUNTY <br /> .0 UED uVIRONMENTAUHSALTIIDEVARANWNT <br /> a) 304 E Weber. Ave 3d Floor Stockton, C.A.952054070 <br /> Ur U 2 1 20 509) 468-3420 Fax: (209)464-0138 Web: www.co,san-joaquin.ca.us/ehd I <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �f�'r`lK3 rrJ�Ur`> BUSINESSIAGENCY: N4` I 1.1N�Qr.�AJ� /YS,SyG/Ftz_j' <br /> ADDRESS;.- ���.- TNF/�Trlal W>��r LJ . c� asIlia <br /> PHONE: d_0 Ci - 30 -3701 FAC -3 S,,►I/M�)ILK: .Z,O CI - 6� - <br /> TENTATIVE"APPOINTMENT DAT w �Qr �� .-, - Time: <br /> (Please allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE RE UST•593-e EE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> 4 FILE ADDRESS ?1 T UNIT <br /> r, steer wes5 4ir t- d;r 51DC o'"I `7 D /!J E) Unit 1 � <br /> z. weal 70S W \, ,z e^ dA at rGr a ✓ . F <br /> 3. s1w., 66 W .)ear <- cl $ ^J ❑ Unit 2 n <br /> 1. Sim �Vi K.l:,e. L.2.,7�R - GI <br /> 5, �Unit3 �'✓h <br /> e. sue )1 / Olt, let <br /> T. street / .7 �^,G��In,� ,y. [ 1 it S ' �Unit4 <br /> a. Slrrel Sd L-I w�u1�NJ 1 C 4& 6r�'�'441J d 5Iv4ij <br /> V Svecl CHY Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )C5 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> ® OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> t& UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> Cl TATTOWBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY C3 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 mall 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 day. <br /> GONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EYo 4fl•eZ-0G4 <br /> aIWz007 <br />