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DATE RECEIVED LIIU LUG NUMUER <br /> SAN JOAQUIN COUNTY <br /> f� �`' EN . ONMENTAL HEALTH DEPAR 1 SENT <br /> . 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> OCT - 2 20W 468-3420 Fax: (209) 46.4-0138 Web: www.co. <br /> fL_NVIRONMENT HEALTh PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 5-1} b t2 L,6fn ,l cl- BUSINESS/AGENCY: <br /> , •� <br /> ADDRESS: 7 �( (.� / Q r Lel C)I U<�c <br /> PHONE: �[7 5-. `( G� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ;.,��1/(.(( r `, ��(1��r DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. Street aty ❑ <br /> . ( Unit 1 <br /> 2. Street Lri L V Cit <br /> 3. Street city ❑ Unit 2 , <br /> 4. Street Cit w, 1 <br /> S. Street City PUnit6. Street Cit 7, Street cit <br /> 8. Street Cit <br /> 9. Street City Unit 5 <br /> ( V <br /> 10. Street Cit C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �-TY� t 1 <br /> (UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> E UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> t HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ' ❑ MOTE(HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ 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 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48.02-006 <br /> 8812003 <br />