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. EHU LUG NUMBER <br /> SAN JOAQUIN COUNY <br /> ENV s�O' NMENTAL HEALTH DE;ARTM r <br /> 3D-4 EAST WEBER AVENUE,THIRD �LOOR <br /> AY 7 6 <br /> ?003 STOCKTON CA 95202 \.- <br /> (209) 468-3420 1 ,300 <br /> : ' :. :'. _ i�iE► PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT.[[t GA.aR j n b,, /JA BUSINESS/AC'ENCYhAP11— <br /> ADDRESS —L_g / y , AV A VP �j-�; C3 �C� �-v •'2 <br /> PHONE `-�� _ ,� /S~ - zS` 1 FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME Z� + 2 <br /> (Please give 7 to 16 busing s days from date of application submittal) I-0 l <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS �� J <br /> SIGNATURE OF APPLICANT ' DATE <br /> FILE ADDRESS THIS SIDE EHD"5TAPF SSIELY <br /> PROGRAM ELEMENTS SEARCH <br /> 73 5a <br /> r <br /> 2 <br /> 1 <br /> u1j, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUXNG ABATEMENT ❑ SOLID WASTE FACILITY <br /> .127'OTHER CLEANUP SITE(MON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> © UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 04 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOIL�TS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA 15-LAND USE PPX,LICATION SITES <br /> 0 MEDICAL WASTE FACILITY OTH1yR(PL ASE SPECIFY) Gt1s- lr 5�, ; <br /> 1. List up to ten addresses in the space ve&14to! t h� type s) of f"r!s fro c lisaboveb ciYecki <br /> thea y <br /> appropriate box(es). At least one fife 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 (90).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 S!'aff 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 ro'leased will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 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 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48.02-006 - <br /> 612003 . S_Iq-a nwh46nX�S n:Yilaar 5-3�• �3 (.� ✓rl7 �:� ��-/,�Cfj �S <br /> R <br />