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DA <br /> p •. 7 . 2004 9 :20AM ENV1RO 209 - 369 4228 No 6331 1-9 26Numbi:7 .. <br /> 0.tu,4 v v,AV u.Lji COUNTY <br /> Rh���I\\�"(�—f(J) ENVIRONMENTAL HEALTHDEPARTMJENT <br /> E��i�—�I 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> SEP 0 � 68-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> qq7 <br /> VR0i\tinLi�T i;F,�`LTHPUBLIC RECORDS RELEASE APPLICATION <br /> ��P'L'ICA'NT- <br /> ADDRESS: <br /> ir:, rSU �-I� (l>\� � U0a-In `- <br /> PHONE: 9��3 , FACSIIMMILGE: lP t` <br /> TENTATIVE"APPOINTMENT DATE: ( � 2D�U Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93. 0 FEE—RE EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Id <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. Street C5 `t G` " " 77 n Ln ❑ Unit 1 <br /> 2. Street a Cit <br /> 3. Street C ❑ Un-it 2 <br /> 4. Street uy <br /> 5. street aty Unit 3 , 71 <br /> 6. street G J <br /> 7. street Ci - Unit 4 <br /> e. Street GtU.7 <br /> 9. street Cit ❑ Unit 5 <br /> 10. Street C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �I UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> �[ UNDERGROUND TANK(M ONITORIN GIRE M OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 99 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEHOTEL 13PUMPER TRUCKIYARD/CHEM TOILETS <br /> U <br /> ❑ TATTOO/BODY PIERCING ❑ 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 checkinc <br /> the appropriate box(es). At least one file type MUST be selected: Fax to(209)464-0138 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 ne) <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 expens. <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revie% <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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 <br /> 8,182003 - <br />