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DATE RECEIVED t� SAN JOAQUIN COUNTY ENEI � EN10 VIRONMENTAL NVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Ave 3`d Floor Stockton, CA 95205 FEB 0 6 2004 (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION APPLICANT: EHD LOG NUMBER BUSINESSlAGENCY: `�-`"'' �'� `�' r^ ADDRESS:lV l-- ' r ` r" PHONE:I y / (- I ?� 2 7 r Ye FACSIMILE: 2- TENTATIVE* APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE —REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT Gl /DATE4 / y Department Use Only I FILE ADDRESS 1. s c`7a3 �4C wr UNDERGROUND TANK (UST) CLEANUP SITE (LOP) kE3ERED THER CLEANUP SITE (NON -LOP) NDERGROUND TANK (MONITORINGIREMOVAL) AZARDOUS WASTE GENERATOR PERMITTED FACILITY ❑ TATTOOIBODY PIERCING ❑ MEDICAL WASTE FACILITY Mfte-y"'-V, 14'111 GH VIAL HEALTH DEPARTMENT FILES � '4— +,-D ❑ HOUSING ABATEMENT SOLID WASTE FACILITY ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE ❑ DOG KENNEL .DAIRY ❑ CHICKEN RANCH CK PKG TREATMENT PLANT ❑ MOTEU}IOTEL 13 'PUMPER TRUCKJYARDICHEM TO ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses In the space above. Select the type(s) of files from the list aboye by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. — Streete C.. V street Q. Skeet 7. Skeet a. Skeet 9. Street 10. Skeet .-•ten nnra► �l UNDERGROUND TANK (UST) CLEANUP SITE (LOP) kE3ERED THER CLEANUP SITE (NON -LOP) NDERGROUND TANK (MONITORINGIREMOVAL) AZARDOUS WASTE GENERATOR PERMITTED FACILITY ❑ TATTOOIBODY PIERCING ❑ MEDICAL WASTE FACILITY Mfte-y"'-V, 14'111 GH VIAL HEALTH DEPARTMENT FILES � '4— +,-D ❑ HOUSING ABATEMENT SOLID WASTE FACILITY ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE ❑ DOG KENNEL .DAIRY ❑ CHICKEN RANCH CK PKG TREATMENT PLANT ❑ MOTEU}IOTEL 13 'PUMPER TRUCKJYARDICHEM TO ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses In the space above. Select the type(s) of files from the list aboye by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. —