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t . <br /> EHD LOG NUMBER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> � 2004 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> OCT (209) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> .n <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> (J- <br /> APPLICANT: CLQ<< a BUSINESS/AGENCY: <br /> ADDRESS: 010 2 V-\ U�cn� t (10 a t <br /> PHONE: <br /> 31(Q FACSIMILE: 2 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> G <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> �- 1d� il �D� <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. street 104 N. S c V 6 O\ <br /> S-A . •� a trod` ,' ❑ Unit 1 <br /> 2. street 3t 4 Z Q co <br /> 3. street 2dp W a Ski e.le�-6v. t hxx� Unit 2 <br /> 1VC <br /> 4. Street TJ i,3 G, maims S-1• G S'�UC�� 1L�`� <br /> s. streetv� S�, ca SL c t �'- ►J� U rn <br /> 6. Street 3-3-40 l=, L5 tlL,r�1 S C y�l� a <br /> 7. Street <br /> 37�8 2 E. C--0_C_-vi_s c,. Prv� aty Unit 4 <br /> 8. Street 3 city S'i'd Z2 <br /> . street �i S i INA co v\ S�t t � Ci S+y0 G(L4 6� El Unit 5 <br /> /a o <br /> 10. Street <br /> 9t 1 3 <br /> t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES OCA <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) <br /> ❑ FOOD FACILITY 13SOUD WASTE VEHICLE UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ POOIJSPA ❑ LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <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 to (209)46"138 or mail to 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 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 /> io <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to re ;Cl <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. Y <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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 <br /> 8!82003 <br />