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06:50 FAX 209 9480621 <br />EHa�.4G.ttA�eEfi <br />DAn r4EQ3VW <br />rj } ' �( }, SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />7 . zQ STOCKTON CA 95202 <br />(209) 468»3420 <br />'; ;ji `°►-��� PUBLIC RECORDS RELEASEAPPLICAfII0N <br />APPLJCJINT_ : ' y ���� 5 _13USWESSIAGENG'Y L -f-- I � � "`� — : -- <br />ADDRESS <br />PHONE _ "�•�-1 �'q '-I � � l'S`f . FACSIMILE � �O g -- 4 '� n - n s �-- r _—....r.�— <br />TENTATIVE' APPOINTMENT DATE 4 _ -nme <br />(please giver to 90 ausiness days from date of appncatlon s.ubm.tial) <br />DiTE AEQUF,ST ^ .00RF-GUEST V SED IN 3 SUSINE:3S DAYS ' ��- <br />CHE=CK eOXTO WE _ I j <br />SIGNATURE OF APPLICANT _ DAT,_ la ? <br />MIX ADDRESS 71 t1a SIOEE EI [D ST AFF USE ONLY <br />PR0GFWW I�L1=l11FAiT3 ^EARCIi <br />6171 <br />- <br />... t72 _tG.ti� �t1 yr y <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />In SOLID WASTE FACILITY <br />0 301.113 WAS rE VEHICLE <br />81 Doig <br />rA PKG TRFATMEII'r PLANT <br />E3 PUI%IP -RTI UGIUYARDICHFZiTOILETS <br />1 <br />"m USE APFUCA-110N SITES <br />C] 0111EI;(PLEASESPECIFY AI;OVE) <br />M UNDERGROUND TANK LUST] CLEAIUp SITE {LOP) <br />t <br />PK OTHER CLEAKUP SRE (NON -IAP) <br />0 FOOD FACILITY <br />t�i; UNDERGROUND TANK (MONrrORING=MOVAL) <br />Q DOG KENNEL <br />Z+O ?,I - <br />N AYd <br />1 <br />❑ moTaMOTEL <br />C3 TATTOWBODY PEIRCIDIGs <br />O •POousPA . <br />0 MEDICAL WASTE FACIL TY <br />FL PUBUC VIATE R SYS -MM <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />In SOLID WASTE FACILITY <br />0 301.113 WAS rE VEHICLE <br />81 Doig <br />rA PKG TRFATMEII'r PLANT <br />E3 PUI%IP -RTI UGIUYARDICHFZiTOILETS <br />1 <br />"m USE APFUCA-110N SITES <br />C] 0111EI;(PLEASESPECIFY AI;OVE) <br />M UNDERGROUND TANK LUST] CLEAIUp SITE {LOP) <br />Ia HOUSING ABATEMENT <br />PK OTHER CLEAKUP SRE (NON -IAP) <br />0 FOOD FACILITY <br />t�i; UNDERGROUND TANK (MONrrORING=MOVAL) <br />Q DOG KENNEL <br />HAZARDOUS WASTE GENERATOR <br />a CHICKEN RANCH <br />TIED PER1NiTTI=D FAC"-n7Y <br />❑ moTaMOTEL <br />C3 TATTOWBODY PEIRCIDIGs <br />O •POousPA . <br />0 MEDICAL WASTE FACIL TY <br />FL PUBUC VIATE R SYS -MM <br />•I. List up to ten addresses In the space above. Select the type($) of flas from th', list above byjchaaing <br />the appropriate boxes). At least one file type MUST be selected. Fxx tc!.t09Z464-)j38 ormail to the. <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for rerriew Will ba confirn7ed. <br />approximately five business days but no later than ten (10) days after re -e ipt of application- The files <br />will be held for a maximum of five business days for review. AppolntmE:nis shpuld be scheduled I <br />accordingly. <br />3. A file that Is actively being worked on by EHD staff may not be Immediately ava(labl+- for review. A n�3W <br />application may be submitted when the file is available. <br />4. Any file not returned In the same condition as released will be reorgani,:e<l'by ;:N13 staff at the expense <br />of the appilcant. Future file reviews by the same applicant may require a 587X; deposit prior to review - <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after'3:00 pm will be processed the next business day. <br />CONFIRMED AppolN wNTOA`tE TIME.— -..-- <br />I DATE CONFIRMED <br />PHONE ' FAX INmIALS <br />I oCnicurGrt via �n JGSac%ro w nn� <br />�- <br />3: Lea ehes,9 e, f0 weA� UOY d Q/1 ' ry : 5 dam <br />F <br />