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SIGNATURE OF APPLICANT DATE <br /> <br />Deportment Use Only <br />CHECK BOX TO EXPEDRE REQUEST - ;93.00 FEE — REOUEST PROCESSED IN 3 BUSINESS DAYS <br />06/02/2006 FRI 9:50 FAX 209999 SJC PUBLIC WORKS ooi/ooi <br />DATE RECEN1F.D <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Ave rl Floor Stockton, CA 95205 <br />(209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca_usichd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />R1111.41.11410•IMEIMIllri3 <br />wpm Aim Claudia Gember ling BUSINESS/AGENCY; San Joaquin County Public Works Department <br />ADDRESS: 1610 E. Razelton Avenue, Stockton, California 95205 <br />PHONE: 953-7624 FACSIMILE: 468-2999 <br />TENTATIVE* APPOINTMENT DATE: Time; <br />(P(ease allow 10 business days from date of application submittal) <br />FILE ADDRESS <br /> i sw,t , ta , / i • i , . " ' u IA <br /> SVest A111111E11 1 <br /> Street MY <br /> 5t991 1 <br /> Street ite Cite <br />I'D 1177ri , i . liriMilli <br /> <br />qw <br />,,Q . , / 0 - , rx iJ .t <br /> sot. 411u0_11. .-41111"4111., PAP Tiliff <br /> Semot 0V 0 4 . <br />19 rt.** g. PrEIMIU. • -.4 e44‘. *W. . MIN <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />LINff <br />Unit 1 <br />Unit 2 <br />gieunit 3 <br />#Unit 4 <br />El Unit 5 <br />OCUNDERGROOND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON-LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />.TIERED PERMITTED FACILITY <br />TATTOO/BODY PIERaNG <br />0 MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT C SOLID WASTE FACILITY <br />FOOD FACILITY 0 SOLID WASTE VEHICLE <br />DOG KENNEL 0 DAIRY <br />CHICKEN RANCH 0 PKG TREATMENT PLANT <br />MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br />POOL/SPA 0 LAND USE APPLICATION SITES <br />OTHER (PLEASE SPECIFY) <br />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). Al least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />address Indicated above. <br />END 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 />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 />Any file not returned in the same condition as released will be reorganized by El-ID staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $53.00 deposit prior to review. <br />'TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received alter 3:00 pm will be processed the next business day.