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FHO L❑G NUMBEK <br /> oATi=RECEIVED � ;3 <br /> I_ �I ��lr �DD PVVIRO:' S.A,N 3OAQU11`l CGUN7CX <br /> 304 E Weber Ave 3"d Float Stockton, CA.95205 <br /> EJ C. 1 LLl 509 468-3420 Fax: (209) 464-0138 Web. wwvv.ca.s�joaquin.ca.t�slebd 14 0 <br /> E10RON;VIENT HEALTH pUBLZC RECORDS RELEASE APPLICATION — <br /> _ ` � � r <br /> APPLICANT: �A' <br /> t"S {r.l��z�1 z BUSINESSIAGENCY: N er- v� A,s,: C <br /> ADDRESS- <br /> PHONE: �_b - -S 7 `3 7 Q k FACZIMIL F., '�'C <br /> TEN'T'ATIVE'APPOINTMENT DAT <br /> e c'. 3�� <br /> (Phase allow 10 business days from date of appiication submittal) <br /> CHE=CK BOX TO EXP501TE RE U ST-$93.0 EE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> . 1 <br /> SIGNATURE OF APPLICANT DAYE �"� � <br /> Depattm¢nT Use Only <br /> FILE ADDRESS UNIT <br /> t. Strcel � �/Je$'( �.r' .1.t.. elf 5'(u C br-� �i a �GJ ❑ Unit 1 <br /> 7. Street a Ln! �IV� C cityarGl� 4D,/ r r F nim <br /> 3. q—t G(5 'j VJ QLI~ �y� cnr�, � .J L-P <br /> [I E1n}f <br /> � <br /> C {V <br /> �/{ <br /> 4. Sir. �l { � Ls-, II , <br /> 2 <br /> Ta r1 . dWN ,t Clt 5'SdG d"j Emit 3; J <br /> i <br /> �{ 1nI es -C ct ri oG <br /> 8. Stra t � Cll <br /> s � i <br /> z Street <br />,: 0. Street sd L,�GlJ1,.�7 t C 'C'�` I.rG^�'r""i5e1J a 'st�C ..► �ri :, �� �r'.{: �w,r �5 <br /> e Slrevt <br /> is 01 ❑ Unit 5 <br /> _ - - <br /> ....................____-------- --- --------- —...._._.._.._..._._ <br /> __..........,.,---._........-�----Cil ......�_..,..._.-.....__...__.._._.__-_-__ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 3" <br /> UNDERGROUi D TANK(UST)CLEANUP SITS(LOP) 17 HOUSING ABATEMt-NT 0 SOLID WASTE <br /> FACILITY <br /> M OTHER CLEANOF SITE(NON-LOP) CI FOOD FACILITY D SOLID WASTE VEHICLE <br /> tR UNDERGROUND TANK(MONITORINGIREMOVAL) iD DOG KENNEL O DAIRY <br /> P!Z-HAZARDOUS wASTi~GENERATOR 0 CHICKEN RANCHO PKC TREATMENT PLANT <br /> ❑ TIERED MRMM ED FACILITY 0 MOTF-UHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> - <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA M LMiD USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ;' Q OTHER(PLEASE SPtCIFY) <br /> JE <br /> f. 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 MU$T be selected. Fax to 209 464-0138 or mall tb 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 submltted when the file is available. <br /> 4. Any file not returned its the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future fife reviews by the same applicant may require a$83.00 deposit prior to review. <br /> 5. . *TENTATiV'E appointment dates must be confirmed with EHD staff. <br /> 6. Applications recelved after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE � TIME <br /> x <br /> TATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Zhu 45-112'4M <br /> a+araaaa �" ' <br /> a: - <br />