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„ <br />011.11: UU t_iLl IU:4(j t'.\_ TU 15J.io52TJ%� i'. IJ_: <br />000 10; 16RM FROM <br />c•o Lx Twat= <br />SAN IAAQUIN COUNTY I[_ HFAt TH CF RyIr_Fi C ,� �� <br />GN\fIRC1 SMENTAI HEALTH DINP.,_W <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 rMlye <br />(209)466-3420 <br />PUBLIC RECORDS RELEASE APPLICATfON <br />APPLICANT 7PWl CODK BUSINESSIAGENCY <br />Annvccc -773 �ti� rv�nGn,✓,L' �. .. <br />/5702 <br />PHONE 1 7,1 <br />TENTATIVE` APPOINTMENT N T <br />AET <br />c�v%� <br />CHECK BOX TO EXPEDITE REQUEST • 57e. FEE -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />-- - ww <br />DATE 12Z ©� <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br />fl UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />Cl OTHER CLEANUP SITE (NON -LOP) ❑ DOO KENNEL ❑ DAIRY <br />❑ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ CHICKEN CH O PKG TREATMENT PLANT <br />u HAZARDOUS RAN <br />WASTE GLNERATOR ❑ MOTEUN RANYLL 13❑ PUMPER TRUCKlYAROEY. <br />ICHTOILETS <br />PERMITTED FACILITY R TIERED ❑ POOUSPA Y LAND USE APPLICATION SITES <br />LlTATT=BODY PEIRCING CIpUaUC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />❑ MEDICAL WASTE FACILITY <br />1. List up to ten addresses in the space above. Select the types) of fifes from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. <br />c . r�Ogt 464.0'138 or mall to the <br />addrel indiGated above, P ointment for review will be confirmed <br />2. END will notify the applicant if any <br />y END files exist. An a p Ilc confirmed <br />The files <br />approximately five business days but no later than ten (10) days after receipt of app <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingiy- <br />3. A file that ir actiV¢ly 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. END staat the <br />4. Any File not returned in the Same condition as released will be reorga` izaeddb y 8. 0 deposit prior t xrev se <br />of the applicant. Future file reviews by the same applicant may req <br />5, `TENTATIVE appointment dates must be confirmed with END staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />FCONFIRIMAEDAPPowrtmENT DATE TIME <br />PHONE FAX INITIALS <br />DATE CONFIRMED <br />YES NO REViEUU' DATE <br />REVIEWEQ <br />TOTAL P.02 <br />