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ENO LUG NUMbER <br /> 11 <br /> F-RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMVNTAL <br /> UHEA-YTH DFPARTNMNT IS I <br /> I , <br /> 304 B W-bei Avc 3rd Floor Stockton, C.A.95205 <br /> 0 68-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/chd .mom <br /> oil UBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENCY .. <br /> APPLI i <br /> .12L <br /> ADDRESS: <br /> PHONE:-&� FACSIMILE:- g9bq 50 X22 rf <br /> - <br /> TgNTAT[VE*APPOINTMENT DATE: or.� a-q ri 5 Time; I e)0 <br /> (Please allow 10 business days from date of application stlbnlittal) <br /> CHECK SOX TO EXPE131TE REQUES -$93.40 PE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE -0 <br /> Department We Only <br /> A <br /> FILE ADDF-9S$. UNIT V <br /> ci ❑ Unit I A <br /> 'NJ ti e, <br /> 3. WWI <br /> 4. Street <br /> SbW Unit 3 <br /> 8. 3ttset tr. str�cv <br /> 0Unit4 <br /> s. Sweat o 0 Unit 5 <br /> 10. SLION <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> G/UNVERGROUND TANK(UST)CLEANUP SITE(LOF) 13 HOUSING ABATEMENT C3 SOLID WASTE FACII-ItY <br /> OTHER CLEANUP SrM(NON-LOP) 0 F09D FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY ow <br /> R E3 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> DOUS 'G 13 MOTELIHOTE), t3 PUMPER TRUCKIYARDICHEMI-TOILET1 <br /> iCa�Tlnr="D PERMITTED FACI'Le <br /> E3 TArMOIBODY PIERCING 0 FOOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECII <br /> 9. List up to ton addresses in the space above. Select the type(S)of filet;from the list'aboye.by checking <br /> the appropriate box(es). At feast one file type MUST be selected. Fax to(209)464-0138orix ail tothe <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 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 iWith EHD staff. <br /> 6. Applications received after 3.00 pm will be processed the next business.day. <br /> CONFIRMED APPOINTMENT DATrz TIME <br /> DATE CONFIRMED PHONE FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> CHO 48-02-OD6 <br /> W9=03 <br />