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DATE RECEIVEDEHD LOG NUMBER <br /> I (­,�!E <br /> I1_\17\17SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM; ENT <br /> 304 E Weber AvC Std Floor Stockton. CA 95205 <br /> SEP 2 9 <br /> fig)468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquiri.ca.us/ehd 20qo <br /> 1r__N V I Fi 0i,I F,i_i1 i H F A L l H <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 303\ > `--C^.fNC- BUSINESSIAGENCY: 6r-0V(ACX 4r cA\ 51j <br /> ADDRI•sS: ti M 'A S�. 2SCCA"/) C—A /^Zo_5-3Z,D <br /> PHONE:_Cz-D�1� B 3S-y gig FACSIMILE: ( 3 F_g g dp <br /> 3 O <br /> TENTATIVE"APPOINTMENT DATE: D O� Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•593. FEE- EQUEST PROCESSED IN 9 BUSINESS DAYS II <br /> SIGNATURE OF APPLICANT — DATE <br /> -- <br /> Department Use Only <br /> FILE ADDRESS UNrT <br /> z. 3--t d 150 41 T I Lj Unit 1 <br /> G <br /> a. weal G ❑ Unit 2 <br /> .. Street � <br /> 6. Sr" Gt \ <br /> e. sic c Unit 3 <br /> 7. Ss­t o <br /> PUnit <br /> a sh-et <br /> 9. St C <br /> ,o. st,t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Jl UNDERGROUND TANK(UST)CLF-ANUP SITE.(LOP) ❑ HOUSIN A3ATEMENT ❑ SOLID` ASTE FACILI-iY' <br /> pS1 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 81 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Nr TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILET'S <br /> ❑ TATTOOBODY PIERCING 11-3 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 fife 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 retumed In the same condition as released will be reorganized by EHQ 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> "044-02.0" <br /> e�aRcw <br /> Td Wd60:b0 b00Z 6Z -daS 2886 828 60Z : 'ON ENOHd s T Sfi(Pud o.iaZ punoaq : W021d <br />