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n oATE�_EC�F1V2DiSAN JOAQUIN COUNTY <br />EHD LOG NUMBER <br />ENVIRONMENTAL Ur-ALTJJ DEPARTMENT <br />[�� 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br />T <br />468-3420 Fait: (209) 464-01.38 Web: v ww.co.san joaquin.ca.us/ehd <br />A/ 44 <br />HC <br />PUBLIC RECORDS RUEAASE APPLICA'T'ION <br />APPLICANT: Q!! 1 �,.,.•, BUSINESS/AGENCY: elf,c <br />ADDRESS: -t�L a4 -- <br />PHONE: 3 — FACSIMILE,�2i <br />TENTATIVE" APPOINTMENT DATE: l .ZO L - Time: C <br />(Please allow 10 business days from date of application submittal) <br />Q CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE –REQUEST PROCESSED iN 3 BUSINESS DAYS <br />DATE � div <br />SIGNATURE OF APPLICANT t <br />67 Department Use Only <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />i/UNDERGROUND TANK (UST) CLEANUP SITE `LOP) <br />❑ HOUSING A13ATF-MENT <br />❑ SOLID WASTE FACILITY <br />W OTHER CLEANUP SITE (NON•LOP) <br />® FOOD FACILITY <br />© SOLID WASTE VEHICLE <br />61, UNDERGROUND TANK (MONITORINGIREMOVAL) <br />E3DOG KENNEL <br />❑ DAIRY <br />[J pOUS WASTE GENERATOR <br />EJ CHICKEN RANCH <br />❑ MOTEL/HOTaL <br />❑ PKG TREATMENT PLANT <br />0 PUMPER TRUCKIYARDICHEM TOILETS <br />Crf TIERED P>=KNITTED FACi1.l1Y <br />© TATTOOIBODY PIERCING <br />C3POOLfSPA <br />O ►AND USE AppLiCATtON SITES <br />O 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 €ist'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 f€ve 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 some applicant may require a $93.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be donfirmed with EHD staff. <br />6. Applications received after 3:00 prn 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 />EKp48-02-068 <br />8/0/2097 . <br />