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Jan 14 09 09:20a Krazan & Associates 5593482190 P.1 DAT r EHD LOG NUMBER �4 LD SAN JOAQUIN COUNTY �'� ENVIRONMENTAL HEALTH DEPARTMENT AN 1 4 2Qnq 304 E Weber Ave 3M Floor Stockton, CA 95205 (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca.us PERM ff/�ERVfCES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: 'TA[,��f,-"PMi NA BUSINESS/AGENCY: _i Rg7p i'� �- NS � orj (}"(res ADDRESS: r 1�i W'. dX CttO Mg—, CQ'\JG C, I"I -,M ,t PHONE: �iS�j— 5�(�S- 73(7 FACSIMILE: — 7� _ �) i'J 00� All TENTATIVE* APPOINTMENT DATE: Time: a ~ (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 DATE ENVIRONMENTAL HEALTH DEPARTMENT FILES UNIT ❑ Unit 1 ❑ Unit 2 Unit 3 Unit 4 ❑ Unit 5 UNDERGROUND TANK (UST) CLEANUP SITE (LOP ❑ HOUSING ABATEMENT `X SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) OOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK (MONrrORINGlREMOVA K NEL 13 DAIRY HAZARDOUS WASTE GENERATOR IC CH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY ❑ PUMPER TRUCKIYARD/CHEM TOILETS ❑ TATTOOIBODY PIERCING ❑ POpLJ ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER ( IFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above 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 END 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. A new 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. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EHD 48.02.006 8/812003 FILE ADDRESS 1. �-y Street -t P \ Cit r 2. Street �' � p j "FRlb C41Y k 3. Street Cit 1 Gt/'� 1 "Street }� i^�.D Ci a city city ^ 1 Cjty 10. Street ..- �� 8EEEI ENVIRONMENTAL HEALTH DEPARTMENT FILES UNIT ❑ Unit 1 ❑ Unit 2 Unit 3 Unit 4 ❑ Unit 5 UNDERGROUND TANK (UST) CLEANUP SITE (LOP ❑ HOUSING ABATEMENT `X SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) OOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK (MONrrORINGlREMOVA K NEL 13 DAIRY HAZARDOUS WASTE GENERATOR IC CH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY ❑ PUMPER TRUCKIYARD/CHEM TOILETS ❑ TATTOOIBODY PIERCING ❑ POpLJ ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER ( IFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above 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 END 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. A new 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. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EHD 48.02.006 8/812003