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�. bRECEIVED .,-- ':;=<, EHD LOG NUMBER <br /> SAN JOAQUIN COUNTS <br /> 00 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2Q0� 304 E Weber Ave 3dFloor Stockton,CA 95205 <br /> N0� (2QW68-3420 Fax; (209)464-0138 Web:www.co.san-joaquin.cams/chd <br /> IS <br /> 1 <br /> t� <br /> Is's�'ti�E PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I UL --BUSINESSIAGENCY: <br /> 7 12 1 t Doc e-`1'— <br /> ADDRESS:��� - <br /> PHONE: D - 7f S- - /4t FACSIMILE: .�_o S` 7Cf'`{- o -- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application subtn'tttal) <br /> i <br /> CHECK BOX TO EXPEDITE REQUEST 9 .00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> —~ ~ <br /> SIGNATURE OF APPLICANT - DATE j ����"' C1 <br /> Department Use Only <br /> FILE ADDRESS UHTT <br /> �_ street ',3 Lj 7,5' ZY. C -LOn C U 6.4- y S�J. ❑ Unit 12 -2. Stree ON <br /> 3. Sheet aty 1 f�- Unit ply <br /> 4. Street G P Z <br /> s. street OtyJ� Unit 3 <br /> 6. sheet a <br /> ty <br /> T. CdVUnit 4 <br /> 8. street <br /> 9. Street a ❑ i Unit 5 <br /> 4o, Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP STIE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> Q TATTOWBODY PIERCING ❑ POOL.ISPA �(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. Anew <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 /> CO,NFfR, MED:APPOINTMENT.DATE s TIME :r <br /> fl%TE COi�fF1RIYiED PHONE : FAX': lN1TIAL.S <br /> RLVIEWED YES NO REVIEW DATE <br /> EHD 4"2-M ` <br />