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TERRACON - RENO :775-351-2423 Aug 12 2010:31 P.01 <br />DATE RisGENBD EHO LOG NUMBER <br />SAN JOAQUIN COUNTY <br />1. '? %t� i ENVIRONMENTAL. HEALTH DEPARTMENT <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />c;. ` - 1.' STOCKTON CA 95202 <br />(209) 468-3420 iq 2*7 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT =.LOC ' `'V_. - BUBINESS/AGENCY e&&AC_ibrQ <br />ADDRESS 61� 6 S -t Z33 S PA (Zls Nj U4 Y:) , <br />PHONE 112 Z5— i ' 2 OQ FACSIMILE <br />TENTATIVE* APPOINTMENT DATE a2-0 TIME <br />2 <br />(Please give 7 to 10 bullness days from data of application submittal)%e <br />l <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE - REQUEST PROCE ED 1N 3 BUSINESS DAYS , _�a^ �N'( <br />SIGNATURE OF APPLICANT W . -�A ' DATE <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />InHOUSING ABATEMENT <br />SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINOIREMOVAL) <br />E3FOOD FACILITY <br />In DOG KENNEL <br />❑ SOLID WASTE VEHICLE <br />C3DAIRY <br />HAZARDOUS WASTE GENERATOR <br />TIERED PERMITTED FACILITY <br />❑ CHICKEN RANCH <br />❑ MOTELIHOTEL <br />❑ PKG TREATMENT PLANT <br />O PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PEIRCING <br />❑ MEDICAL WASTE FACILITY <br />O POOLISPA <br />❑ LAND USE APPLICATION SITES <br />❑ 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 checklna <br />the appropriate box(es), At least one file type MUST be selected. Fax to (299) 464-0138 or mail to the <br />gddrasg jaO.Icatod abov . <br />2• EMD will notify the applicant If any EMD 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 hold 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 same 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 PHONE FAX INITIAL <br />REVIEWED YES NO REVIEW DATE <br />E}ia M -0z-006 <br />o�raoraooa <br />M <br />