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DATE RECEIVED t:HD LQQ NUMBER <br /> SANJoAQclrN COUNTY <br /> ' <br /> ENVIRONMENTAL HEALTH Els PAR{ MENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 0 C2 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co,san-joaquin.caa -lad b <br /> n 1' / PUBLIC RECORDS RELEASE APPLICATION t - <br /> APPLICANT: Y.Y"J� 1e-r,c-G•a (� BUSING ESSIAGENCY: !V is�] . /`rY`ry-��l SGt� •••F fS��a"C' . <br /> ADDRESS: 'I O�] I n(�n�C ^ '��C ��'I t L&7rn <br /> PHONE: -�-'• "J��'>_J ` FACSIMILE <br /> I / <br /> : <br /> ! 0, <br /> � ( <br /> TENTATIVE'APPOINTMENT DATE: 5I ' ! 0 Time: <br /> (Please allow 10 business days from date of application submittal <br /> l CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � Ji7 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. Street i�Zs r% 0.GY0. �-l'� 51E- C1 �A." <br /> z. Meter 11-7-`I 5• Sae S 1 ell oU O Unit 1 <br /> 3, syeal CU <br /> C7 Unit 2 <br /> n. seem cin <br /> S. stfw "I <br /> nit 3 <br /> . B. Floral CII <br /> 7. Flrcm Gly ,Unit 4. . <br /> 8. SIMI CII <br /> u ' <br /> Q, Siraet CII N I"t (knit rJ <br /> 10. Syeel Y,. CI IV LJ <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> "- UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILITY <br /> 'CL OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY In SOLID WASTE VEHICLE <br /> IS UNDERGROUND TANK(MONITORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL t7 PUMPER TRUCKI"YAROICHEM TOILETS <br /> Cl TATTOOlaODY PIERCING ❑ POOLJSPA ❑ 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 EHO 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 EMD 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 EMD 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 /> e14D 60-87,•aae <br /> Ban= - <br />