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09/06/2005 09:37 2093694228 NEIL ANDERSON ENVTRO PAGE 03/03 <br /> EMO LOG NUMBER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> RECES EN' 1Vti,VZRONENTALHEAL.;r DEPARTMENT <br /> 304 E Weber Avc 3'd Floor Stockton, CA 95705 <br /> $FP — G N$09) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/elld 177 <br /> F�l`J1ROPlP�'lE�A NrV( PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SUSIINESS/,AGENCY: <br /> ADDRESS:,41() <br /> U-')aq'! 11-- <br /> PHONE: ( _—FACSIMILE: �//A <br /> TENTATIVE*APPOINTMENT DATE: dt 20 Time: I LO <br /> (Please allow 10 business day;from date of application submittal) <br /> © CHECK 13OX TO EXPEDITE REQUEST-393-00 FEE=REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �C/ l'JG;L I {{ DATE q-6r <br /> f w, Department Use Only <br /> 51LE ADDRESS UNIT <br /> ,, stmel e'(\0V' F p Unit 1 <br /> o�c Ur ,^.r� 5 lP0 pSe <br /> City rn �° rt^.�JI l-0 11-0 Unit 2 �S <br /> 4. Slrt?rl C) <br /> city Tf Gtr up Y Y\. ISd V <br /> $, Stmrl Dly ZUnit <br /> 8. Sheet Gly <br /> 7 Strcm _ C1ly Unit 4 <br /> a. Street Glly _ <br /> A. Slmrl .clty, ❑ Unit 5 <br /> to. Street cl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 63'OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY o SOLID WASTE VEHICLE <br /> Cdr UNDERGROUND TANK(MONITORINGIPEMOVAL) p DOG KENNEL D DAIRY <br /> WAZARDOUS WASTE GENERATOR D CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> VTC>a TIERED PERMITTED FACILITY 0 MOTEUHOTEL L PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING O POoUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 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 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 /> 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 /> 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 with EHD staff. <br /> 6. Applications received after 3:0D 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 /> 8/tS�2009 <br />