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TERRRCON - RENO 775-351-2423 Rug 12 20 10:31 P.01 <br /> DATE RECISM0 <br /> SAN JOAQUIN COUNTY EMO LOG NUMBER <br /> Irk ;u�i ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION Iq 7 <br /> APPLICANT 706 ft c-6<6 BUSINESS/AGENCY <br /> ADDRESS 13 BQ GiR—CG S -tZ,73 Pf4R. V 4 y:) <br /> PHONE �S'I ` 2 yQp FACSIMILE - — <br /> f <br /> TENTATIVE*APPOINTMENT DATE20 TIME <br /> (Please give 7 to 10 bu ness days from data of application submittal) <br /> u CHECK BOX TO EXPEDITE REQUEST. , <br /> $83.00 FEE—REQUEST PROCE ED!N 3 BUSINESS DAYS 1%1,.\ �A <br /> SIGNATURE OF APPLICANT DATE �' (L' D� 2 <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> t C- Mmuc , <br /> 5 7 <br /> Tilm <br /> HI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP 817E(NON-LOP) ❑ FOOD FACILITY ❑ 30LID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINOIREMOVAL) n DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL n PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOBODY PEIRCING ❑ 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 99)484-0138 Dr mail <br /> ddre d sated a OVE. <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 END 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 END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONEFAX INITIAL <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> F.ga w.oa� <br /> o�roonoos - <br />