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04 -1b -2E21 TO 192594W -I632 P.01 h iJn 1. kc:2lVCD — �} tNULUY SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES 1WY ENVIRONMENTAL HEALTH DIVISION APR 1 7 ZOO( 304 EAST WEBER AVENUE, THIRD FLOOR } STOCKTON CA 852(12 hi I II I TL; (20s) 466-3420 e F - PUBLIC RECORDS RELEASE APPLICATION _ d7 APPOI UCANT I�-�%yL CHTjAf CPyS 7-jy-NTDSWE3&AGENCY L! e -el C 9/W (f 0/(/ ADDRES_SiTo5;,TYFS j7L 6' w,r�. 20 -5 - PHONE FACSIMILESol' -165 Z __- TENTATIVE' APPOINTMENT DATE_ Lf I Z' 7 < A I TIME _ / : a I (Please give 7 to 10 "Irleas days from data oI oppilcatim submittsi) CHECK SOX TG EXPEDITE REQUES"T�a�7.00 FFE`E- REQUEST PROCJ SSEEDD N 3 DUUFL4FSS DAYS / SIGNATURE OF APPLICANT 6� tet- �'-'-v"�``y.r- ¢f��.--�'+/'V�— DATE T l7 Q O I� ENVIRONMENTAL HEALTH DIVISION FILES n��D NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ADATtJ&NT &SOLID WASAmp,llLll'�HER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLIBWAS dNOERGROUND TANK (MONITORINWREMOVAL) ❑ DOG KENNEL M CWRr MAY - 1 ? �' A7ARDOUS WA9'TE GENERATOR ❑ CHICKEN RANCH 13 PKG TREATMENT PLANT ur TIERED PERMITTED FACRTLY ❑ MOTELHOTEL C3 PUMPER TRUCKJYARDlCHEAt TOILETS VATTOOMODY PEIRCING O POOLBPA ❑ LAND 032 APPLICATION SimsEAICAL WASTE FACILT' L7 PUHUC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) 1. List tip to tan addresses In the space abovo. Select the typo(&) of files from the list above by checking the appropriate box(es). At least one file type MUST be Selected. Fax to NO0j 46"138 or mail to th address inalCated ai- e 2. EHO will notify the applicant if any EHD files exist. An appointment for review will br conflrmed epproxlmataly five business days but no later than ten (10) days after receipt of application. The flies will be hold for a maximum of five bustnes4 days for review. Appointments should be scheduled accord[ngly. 3. A file that is actively being viorked on by EHD StoN may not be immediately available for raview. A new application may be submitted when the file is available. 4. Any file not ratunned in the same condition as released will be reorganized by EHD staff at the ense ex Of the apPIICant. Future file reviews by the same applicant p PP nm Y require a 587.06 deposit prior to review. 5. •TENTAT VE a ppointment dates must be confirmed with EHD staff. 6. Applications racotvid after 3:00 pm wHl be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS ... . STAFFUSE a NLY THIS PROGRAM ELEMENTS SEARCH �•iles • ' t �Z'3�e-'.tilGi'li%i"��(1;�:J7rF yy - ' • ' � i� • . _. : _ - . - � .rte©n�� �■■� O I� ENVIRONMENTAL HEALTH DIVISION FILES n��D NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ADATtJ&NT &SOLID WASAmp,llLll'�HER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLIBWAS dNOERGROUND TANK (MONITORINWREMOVAL) ❑ DOG KENNEL M CWRr MAY - 1 ? �' A7ARDOUS WA9'TE GENERATOR ❑ CHICKEN RANCH 13 PKG TREATMENT PLANT ur TIERED PERMITTED FACRTLY ❑ MOTELHOTEL C3 PUMPER TRUCKJYARDlCHEAt TOILETS VATTOOMODY PEIRCING O POOLBPA ❑ LAND 032 APPLICATION SimsEAICAL WASTE FACILT' L7 PUHUC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) 1. List tip to tan addresses In the space abovo. Select the typo(&) of files from the list above by checking the appropriate box(es). At least one file type MUST be Selected. Fax to NO0j 46"138 or mail to th address inalCated ai- e 2. EHO will notify the applicant if any EHD files exist. An appointment for review will br conflrmed epproxlmataly five business days but no later than ten (10) days after receipt of application. The flies will be hold for a maximum of five bustnes4 days for review. Appointments should be scheduled accord[ngly. 3. A file that is actively being viorked on by EHD StoN may not be immediately available for raview. A new application may be submitted when the file is available. 4. Any file not ratunned in the same condition as released will be reorganized by EHD staff at the ense ex Of the apPIICant. Future file reviews by the same applicant p PP nm Y require a 587.06 deposit prior to review. 5. •TENTAT VE a ppointment dates must be confirmed with EHD staff. 6. Applications racotvid after 3:00 pm wHl be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS