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DATE f2f=CETVED SAN JOEHD LOG NUMBER
<br /> A.QUIN COUNTY
<br /> � Ir "'JiIt
<br /> C_ 0�- ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 1L� � 304 E Weber Avc 3d Floor Stockton,CA 95205
<br /> da�9)468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.us/e1Ld
<br /> pec ��o z
<br /> -- _ PUBLIC RECORDS RELEASE APPLICATION
<br /> AP� S � BUSIKESSIAGENCY: A 4
<br /> ADORES.,:? r'A .._.
<br /> PHONE: 2Q9 L'Ke7-I OOG. FACSIMILE: z$4- t(,G
<br /> TENTATIVE*ApPOINTmeNT DATE: 12.— Time: OQ A.�
<br /> (please allow 40 duslnQ a days from date of appllcallon subn*tuQ
<br /> CHECK BOX 70 EXPEDITE REQUEST.$93.00 FEE
<br /> L—fREOUE37 PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF:APPLICANT �^�T�� _ DATE
<br /> Deparkwt Use Only
<br /> FILE ADDRE=SS UNIT
<br /> �. aJ" c 46.04co, a
<br /> smr,i a Hca �� r Wl� d D Unit 1
<br /> a svaa ewe ❑ Unit 2
<br /> t. suedox (�
<br /> s easel
<br /> CKV Unit 304. '
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<br /> Unit 4
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<br /> o. week0hy Unit 5 i
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<br /> ENVIRONM>=NTAL HEALTH DEPARTMENT FILES
<br /> K_-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 13 SOUD WASTE FACILITY
<br /> BOTHER CLEANUP SITE(NON-LOA) 17 FOOD FACILITY M SOLID WASTE VEHICLE j
<br /> UNDERGROUND TANK(MONITORING111E NOVAL) M DOG KENNEL 0 DAIRY
<br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH [7 pg(G TREATMENT PLANT
<br /> 0 TIERED PERMITTED FACILrrY ❑ 540TELIHOTEL 0 PUMPER TRUCKIYARDICHEN TOILETS
<br /> 0 TATT00113013Y PIERCING IM POOUSPA d LAND USE APPUCATION SITES
<br /> D MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY} _-- _ -• i
<br /> 1. List tip to ten addresses in the space above. Select the type(s)of tiles from the list above by checking
<br /> the appropriate box((*). At least one file type MUSS'be selected. Fax to(2091464.0138 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 give 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 flie 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 priorto review.
<br /> 5. IMNTATNE appointment dates must be confirmed with EHD staff.
<br /> 6. Applications received after 3:00 pm will be processed the next business day.
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