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REVIEWED NO REVIEW DATE <br />, / <br />DATE CONFIRMED ,', n PHONE FAX INITIALS /14 <br />CONFIRMED APPOINTMENT DATE el </ TIME <br />SAN JOAQUIN COUNTY <br />ENV_ JNMENTAL HEALTH DEPARTATT <br />304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />(209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPUCANT: <br />ADDRESS: <br />PHONE: <br />/a 4 4/4 /,-C BUSINESS/AGENCY: ,S <br />f?7_ <br />/7 / 11-74,01. (2 -s J k 51-A Li) <br />-7c FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: —/ C-( /<7/0 Time: <br />(Please allow 10 business days ,,from date..of plication submittal) <br />0 CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE - RE <br />SIGNATURE OF APPLICANT <br />'3 BUSINESS DAYS <br />DATE C <br />Department Use Only <br />FILE ADDRESS _ ia....._ <br />—1—.--Streee .102 41.• .1.1•klaniMPIEW • City <br />2 Street (e0 C--(C) 7-77 ' v /---YV CitY r '1,-/Ii /-i-4...) <br /> Street City <br /> Street City <br />5 Street City <br /> Street City <br /> Street City <br />S. Street City <br />9 Street City <br />10. Street City <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />Uniti <br />1:1 Unit 2 <br />Unit 3 <br />Unit 4 <br />Unit 5 <br />CYLI-t-riDERGROUND TANK (LIST) 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 PIERCING <br />MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT <br />FOOD FACILITY <br />DOG KENNEL <br />CHICKEN RANCH <br />MOTEUHOTEL <br />POOUSPA <br />OTHER (PLEASE SPECIFY) <br />SOUD WASTE FACILITY <br />SOLID WASTE VEHICLE <br />DAIRY <br />PKG TREATMENT PLANT <br />PUMPER 'TRUCK/YARD/CHEM TOILETS <br />LAND USE APPLICATION SITES <br /> <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). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />address indicated above. <br />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 />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 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 />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />61-0 48-02-006 <br />81E42003