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UFiIt: Ktt,cIYCU <br />SANJOAQ UIN COUNTY - <br />u ENVI ENTAL HEALTH DEPART <br />Ar <br />304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />(209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />PUBLIC RECORDS RELEASE APPLICATION lqq <br />APPLICANT: SitJJ r 9 4 ; . T �' � BUSINESSIAGENCY: <br />ADDRESS: S-9 //2 C f2 c re f,(— C t` r i 1 �; J�/ ✓yJdr <br />PHONE: Z�— (�} 3 Il 0 FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE:Time: <br />1AH 24 <br />(Please allow 10 business days from date of application submi <br />® CHECK BOX TO EXPEDITE REQUEST - =9 . m E — REQUEST PROVESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT c DATE <br />LDepa12- <br />Department <br />rtment Use Only <br />UNIT <br />p Unit 1 <br />® Unit 2 9A/ <br />�> <br />Unit 3 �. <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Milk <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY WW <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />❑ FOOD FACILITY <br />❑ DOG KENNEL <br />❑ CHICKEN RANCH <br />❑ SOLID WASTE VEHICLE <br />❑ DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTEUHOTEL <br />❑ PUMPER TRUCK/YARDICHEM TOILETMElk <br />❑ TATTOOBOOY PIERCING <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to 1209) 46.4-0138 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 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 />ONFRMED APP®INTMENT DATE. ' :: TIME <br />pATECONFiRMED. .. PHONE :. FAX"_: INITIALS <br />REVIEWED YES NO REVIEW DATE <br />EHD 48-02-006 •. <br />&WM03 <br />