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DATE RECEIVED EHD LOO hUMMR <br />SAN JOA IN COUNTYPUBLIC HEALTH SEES <br />Iola ENVIRONMENTAL HEALTH DIVISION o a <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />[ E <br />STOCKTON CA 95202 <br />(209)468.3420 NOV 1 3 ZOOZ <br />PUBLIC RECORDS RELEASE APPLICATION pLTH <br />APPLICANT_PQUI RIMA BUSINESS/AGENCY r Dne _r'C- PEW/SERVICES <br />ADDRESS c�80 LJain�t Avenge , Su"te 1 use nrrCR <br />PHONE $M -Q - t7 FACSIMILE ly - (0cog -90Q-Ls -- <br />TENTATIVE" APPOINTMENT DATETIME <br />rU <br />(Please give 7 to`'10 business days from date of applioaUon submltlal) 1/ 3 Cl: �'.'; <br />I] CHECK BOX, TO EXPEDITE REQUE �Ej- REQ ESSED IN 3 BUSINESS DAPS <br />DATE <br />SIGNATURE OF APPLICANT <br />0 <br />N <br />0 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />.'ES'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />❑ FOOD FACILn'Y ❑ SOLID WASTE VEHICLE <br />BOTHER CLEANUP SITE (NON -LOP J p OOG KENNEL ❑ DAIRY <br />.UNDERGROUND TANK (MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />, . HAZARr)OUSWASTLGFNEPATOR ❑ MOTELMOTEL ❑ PUMPERTRUCKIYARD/CHEMT:IILETS <br />❑ TIERED PERMITTED FACILH`Y CI ppOUSPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOBODY PEIRCING ❑ PUBLIC WATER SYSTEM In OTHER (PLEASE SPECIFY ABO IE) <br />❑ MEDICAL WASTE FACILITY <br />List up to ten addresses in the space above. MUST <br />the types) of fifes from the list above by dielj.to the '1 • a MUST he selected• Fa to 209 464-0138 or mail_to the :. <br />the appropriate box(es). At least one file It <br />address indicated a Dve. ointment for review will be confirme:l <br />2. EHD will notify the applicant if any EHD files exist. An app p Ile onfir The flies <br />approximately five business days but no later than ten (f 0) days after receipt of app <br />will be held for a maximum of five business days for review. Appointments should be schedul ad <br />accordingly. <br />3. A file that is actively 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. <br />4. Any file not returned in the same condition as released <br />I will <br />be ma reorganir q iire.a $78.00 depo t prior Io.review. <br />ed by FHD staff at the jIXpen5$ <br />of the applicant. Future t7{e reviews by the same applicant Y <br />S. '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 <br />TIME •- <br />DATE CONFIRMED <br />PHONE FAX INITIALS _ <br />... .,� vFs NO REVIEW <br />DATE — <br />