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BUSINESS/AGENCY: A74.7/v c 4 <br />APPLICANT: <br />ADDRESS: <br />PHONE: <br />TENTATIVE* APPOINTMENT DATE: li-Uj <br />(Please allow 10 business days from date of applic <br />C( <br />FACSIMILE: <br />- <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTM4Mf <br />HvkJNH[flI Ai. HEAL1}B04 E Weber Ave 3rd Floor Stockton, CA 95205 <br />rj169)`4;6`g V420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.usiehd <br />03 AUG 3 AM IaLIC RECORDS RELEASE APPLICATION <br />El CHECK BOX TO EXPEDITE REQUEST -4.93.00 FEE — RE UEST PR CESSED IN 3 BUSINESS DAYS <br />DATE 2J- SIGNATURE OF APPLICANT <br />Department Use Only <br />FILE ADDRESS <br />1. street ,4/0„-t" ii,4,,,J,,,,,,- A ,z _7-.6 City <br />Street -7-Z(1 ///.. cae<..., 4 r/. ..11) 2 7g City _S-710 , ile,y„, ‘S <br />3N,/ Street . cr, -X-J-e.,,...- -, (-_,Z- -.5-14:- S b ...36-21/cty (-74., ,..9.0.5-0 <br />4. Street 1/21/--//c..,.....t 674 6,_ ..r- 0 3694( City c/, ,. / /77 ,-,_ .76-- <br />*574 Street r 1 t; \:, -4 City , ) 1 Street City <br />Street <br />Ei. Street <br /> 1 <br />Street 1.1 JA <br />Street Cit____. <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />El SOLID WASTE FACILITY <br />El SOLID WASTE VEHICLE <br />El DAIRY <br />El PKG TREATMENT PLANT <br />El PUMPER TRUCK/YARD/CHEM TOILETS <br />El LAND USE APPLICATION SITES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON-LOP) <br />14: UNDERGROUND TANK (MONITORING/REMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />El TIERED PERMITTED FACILITY <br />TATTOO/BODY PIERCING <br />MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT <br />El FOOD FACILITY <br />DOG KENNEL <br />CHICKEN RANCH <br />MOTEL/HOTEL <br />POOLJSPA <br />OTHER (PLEASE SPECIFY) <br />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 />EHD will notify the applicant if any END 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 />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 />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 />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />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 />818/2003