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- 209'532.0773...:° P <br /> Y=13-2004 ;:15 11 ":C❑ND❑fZ-EARTH'�TECW ~` f EHD LOG NUMB <br /> )ATE RECEIVED SAV JOAQUIN COUNTY i <br /> r' F'Fg D 19�ONMENirAar.., THDM zx�v x <br /> � <br /> L D 304 E Weber Ave 3,1Floor Stockton,'CA 95205 <br /> 9)468-3420 Fax: (209)464-0138 Web:w_ ww- -co.san j4aqui�a.ca.tis/ehd <br /> SEP 13 <br /> 2 E <br /> ENVIRONMENT HEALTH <br /> RECORDS RELEASE APPLICATION <br /> C i f!11 i i ijLJSiNESSrAGEl1CY: <br /> APPLICAr T, <br /> ADDRI=sS: / L1 V' <br /> 1 <br /> PfiOH FAGSIIltILI=: <br /> -. 0$ Time: `1tQllt• - <br /> TENTAT1vI APPomrrmEur DATE: <br /> (Please allow 10 busifleas dns ffam dpto aF appn"I aubmlttail <br /> CHECK DOX TO EXPEME RE ST-Snoa FEE--REQUEST PROCOSED IN 3 SUSUn=DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT f <br /> Departsner,t Use only I <br /> UNIT I <br /> FILE A>7DRES3 <br /> . NA tiv�- <br /> wA aro ❑ Unit S <br /> I <br /> 3, MaeS. lku HY a Unit <br /> 0A --> s. s.ea Si7 W.' ieG �j <br /> r. skeet , 1(o I Mrc.G Ea O <br /> 7. sem, 1 Cky nit 4 <br /> IN- SITS& 1 (2 -7171 0 <br /> a- S1201, 147,717 COLCAI 5 <br /> ,a. stree� 15-1t 7 14VB tPeJV. <br /> ENVIRONMENTAL HEALTH pEPARTM ENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP Sn'E(LOP) [3,HOUSING ABATEMENT SOLD WASTE FAC(Lny <br /> OTHER.CLEANUP 517E(NON-LOP) — ❑ FOOD FACILITY t SOLID WASTE VEHLCL.E <br /> .M UNDERGROUND TANK(MONIMORINGIREMOVAL) II DOG KENNEL ❑ DAIRY <br /> 1Z HAZARDOUS WASTE GYRATOR 4 CHICKEN RANCH 0 PKG TREATMEN71'PLlWr <br /> )z-T>ERRI D PmmrnED FAaLiTY 13 M0TEL1NOTEL C] PUMPER TRUCKfYARDIGHEM TOa.ETS <br /> ❑ TATrOOMODY PIERCING ❑ POOLISPA LAND USEAPPLICALIQN SrMS <br /> CI MEDICAL WASW FAciLTTY ❑ 01(PLEASE SPL:CiF7} <br /> 9, List up to ten addresses in the spate abov& select the type(s) of files from the list aboye by checkin', 5 <br /> the appropriate box(es). At least one fila type MIDST be selected. Fax to =21464-6138 or mall-to tho <br /> address indicated above_ <br /> 2- EHD will notify the applicant if any END files exist An appointment for review will be Genf rrned <br /> approximately five business days but no later than ten(10) days after rvaelpt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should 6e scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by END staff may not be immedlataly available for review. A.ne <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 END staff at the axpCnt <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to•mevia <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATI~ TIME . <br /> DATE CONFIRMED 'PHONE . FAX.- JNI TtALS' I <br /> REVIEWED YES NO REVIEW DALE _ <br /> TOTAL P.O., <br />