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2©'d �u10.1 enc lou xwaan I' <br />carr rtrc�orn- - <br />SAN JOAgU1N COUNTYPUSLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE. THIRD FLOOR iI„ Id 1 �Oli1 <br />STOCKTON CA 45202 <br />H <br />PUBLIC RECORDS RELEASE APPLICATION <br />EWSWESWA13ENCY iY rl r <br />APPtxANr J' ` <br />ADDRESS I'!� s, r�rr�_ Af, �h t, 14 C k • g <br />TACSIMAE <br />TENTATIVE• APPOINTMENT DATE .:&I A0- rcMe <br />(Pl.aso a:va r W nusiruxa days Irdm dale of ayPYCalmn nunmidal) <br />teal /-3 a, <br />El CHECK Box TO EXPEDITE REQUEST -A9.00 fEE- RE uzyP C)CES5rb IR3HDSWFSSDAY$ <br />SIGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH DIVISION ` v'/uvuu <br />UNDERGR6JND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT <br />6S SOLID WASTE FACILITY JUN <br />.TEL <br />Id OTHER CLEANUP SITE (NON4LOP) <br />LA MOD FACILITY <br />rl SOLID WASTE VEHICLE <br />M DAIRY <br />OSUNOERGROUNDTANK (MONITORiNG(REfAOVAL) <br /><�Lrtt 30 7,2(0/ 9 <br />z3(,a,3 <br />23oY (o <br />1 ('�c.iit ryR <br />O PUMPER TRUCY"ARDICHEM TOILM <br />O Tn,RE0P£RMrR£DFACILITT <br />13 TAYTDOIBO DY PE1tiGWG <br />rMO <br />U POOUSPA <br />O LAND USE APPLICAMON SITES <br />0 OTHER (PLEASE SPECIFY ABOVEI <br />O 1A WASTE FACILITY <br />D PUBLIC WATER SY5TEM <br />Nr Li {C', <br />a <br />22- <br />L�,:cotl._ ���,�'(� <br />� , c�l..lV�H�;QTctz=„�nr-s <br />31c 23 /,212/ Z30' <br />253/ <br />b 1r <br />Gr as r✓Ir <br />ENVIRONMENTAL HEALTH DIVISION ` v'/uvuu <br />UNDERGR6JND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT <br />6S SOLID WASTE FACILITY JUN <br />.TEL <br />Id OTHER CLEANUP SITE (NON4LOP) <br />LA MOD FACILITY <br />rl SOLID WASTE VEHICLE <br />M DAIRY <br />OSUNOERGROUNDTANK (MONITORiNG(REfAOVAL) <br />❑ DOG KENNEL <br />0 CHICKEN RANDS <br />R pKG TREATIAENT PLANT <br />2¢ HAZARDOUS WASTE GENERATOR <br />0 MMUMOTEL <br />O PUMPER TRUCY"ARDICHEM TOILM <br />O Tn,RE0P£RMrR£DFACILITT <br />13 TAYTDOIBO DY PE1tiGWG <br />rMO <br />U POOUSPA <br />O LAND USE APPLICAMON SITES <br />0 OTHER (PLEASE SPECIFY ABOVEI <br />O 1A WASTE FACILITY <br />D PUBLIC WATER SY5TEM <br />/ /603 <br />`7,1301 23Yo <br />134+0 <br />Z36.7 - <br />sees 5'Z <br />9 see• <br />1. List UP to ton addresses In the space above. Select the type(s) of tiler; tram the Itat above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax. to 1�49k 4644118 or maj! to <br />addres, 6icated above <br />2. HHD will notify the applicant if any E H D files exitL An appointment for rev ICw will be confirmed <br />approximately fare business days but no later than ten (10) days atter rseeipt of appllGation, The Was <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 an by END staff may not be immediately available toe review. A now <br />application may be submitted when the file is availahte- <br />4. Any file not returned in the name Condition a5 released will be reorganized by END staff at the expense <br />of the appucarH. Future fllc reviews by thw same applicant may require a $70.00 deposit prior to review. <br />S. 'YENTATM appointment dates must be confirmed with END staff. <br />6- Applications received after 1:00 pun will be processed the neXt business day. <br />200 <br />r.'82bFlbp <br />0.1 <br />"-i Wd9r:c-'l3 656T-LO-ZI <br />