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G'' AN COUNT) EHD LOG NUMBER <br /> I tRo»NmENTAL HEALTH DEP RI<J E;NT <br /> L; 2 1 05 304 E Weber Ave 3�a Floor Stockton, CA 95205 - <br /> ��Q <br /> EN�J6?O�Is��E'� tic' )468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca.us/ehd <br /> 1 <br /> PEW11IT/CL VICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> r <br /> APPLICANT:[[jj 1� � __,__EUSINESS/AGENCY: Aid / 1/1 <br /> , i L.� �•.-- <br /> ADDRESS: <br /> aloZ <br /> PrIONE: r9m �-3101, —FACSIMILE: 3��- �f225f_ <br /> TENTATIVE"APPOINTMENT DATE: v\ Timm: AN — <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK SOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4�wk DATE 12 -1 <br /> DQPWtment Use Only <br /> p/ FiLE ADDRESS UNIT <br /> y'L'V 1 AL E7® ❑ Unit 1 <br /> Z. Strerl OI Qe V �Q CPN skvc <br /> 3. Sircrl Cil 'IaG�ASGST— a Unit 2 4 <br /> 4. sires UUct cod + CIG S <br /> s. sty cZd35 C.tnera ca ��C K ►'I �, Uh <br /> y�E <br /> 6, Street tw Gt l UC �. bf ud a <br /> T. Sorel C71 e c `r Iva 5'i.c'kr •� Unit 4 <br /> S, street ❑ Unit 5 <br /> —f ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> G UNDERGROUND TANK(U"CLEANUP Si'i'E(LOP) ❑ HOUSING ABATEMENT Gi SOLiD WASTE F'ACILI'TY <br /> W OTHER CLEANUP SITE(NON-LOP) Ci FOOD FACILITY r3 SOLID WASTE VEHICLE <br /> [;//UNDERGROUND TANK(MONrrORiNGiREMOVAL) p DOG KENNEL O DAIRY <br /> ;/�iAZARDOUS WASTE GENERATOR Q CHICKEN RANCH L7 PKG TREATMENT PLANT <br /> [ TIERED PERMITTED FACILITY ❑ MOTELtHOTEL 0 PUMPER TRUCKIYARDICHtM TOiLETS <br /> ❑ TATTOOIBODY PIERCING <br /> E3 POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY CI OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fist"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 saltie 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 P=HONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DAT E <br /> BNP 4a.02.00e <br /> R/ttf2003 <br />