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SAN JOAQUIN COUNTYPUBLIC HEALTHRVICES LHD LU(:Nue.R'4 IRONMENTAL HEALTH DIVISI `TD4 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (249) 468-3420 PUBLIC RECORDS RELEASE APPLICATION APPLICANT icMARD L74w5D.-1 BUSINESS/AGENCY &Co +`J t, ADDRESS -Z-a1 _� 7 Z`t 0 1 A L1�. PHONE Z-0"t J&P1 OZ-13 FACSIMILE c';10 6 C09 C31—A TENTATIVE'APPOINTMENT DATE f n k(Z.(_'A to IL00co TIME 00/065 (Please Hive 7 to 10 business days from date of application submittal) p ely" © CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE-REQUEST PROCESSED 1N 3 BUSINESS DAYS MAR SIGNATURE OF APPLICANT t�-l,.rn�1l �pwl3crrJ� DATE OV7 OQ FILE ADDRESS I a LWUU li I rJ1~za t_f4TUr.j MARU SU-1 SFT-1✓("tRs�1S�Csf� �1�1 5W SFT u-� .".r'r �f�l P�Ika wta 40 Fit v CO�otini3c�f Zc)�,CA6JA. IyN S,t,t�7cut.IJ w�� v `�A ►v,r:f r� KLO'� 2AL-V PA1211L.9 till NAVY C�2sVt rs�; -- 2VGt45ToP loo+ o� SDHs N ,zA4. ur — ([� to,.] STr�rt_ 5i5 W, GMAFy_ V o frG l.l.t I o 5r C(), 939 W, C-41 ,2,�W._ 02—c= NAV ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY ID OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY C1 SOLID WASTE VEHICLE 0 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY 0 MOTFLIHOTEL ❑ PUMPER TRUCK1YARDICHEM TOILETS ❑ TATTOOIBODY PI_IRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the Space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to f209) 464-0138 or mail to the address indicated above 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. "TENTATIVE appointment dates must be confirmed with EHD staff. 6• Applications received after 3:00 p n will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE ere oa is ovasrao