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I LIN LOU Numu/B <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH CERVICES <br /> IVIRONMENTAL HEALTH DIVISI`/ <br /> '304 EAST WEBER AVENUE, THIRD FLOOR I W"SE <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT '?N%ARD 1.. VAwS O.-I BUSINESSfAGENCY �o-'VASE E�V'1ft-O�-J NL47-I'rR C- I^I L <br /> ADDRESS Za\ 3 7 VEAA"ViW✓t NJC it"S'S Z- -1 c7 1A0Ti-S-z) C.A RS-6 5 t. <br /> PHONE Z09 S(.1 OL93 FACSIMILE;1&9 51o9 CtA '15— <br /> TENTATIVE'APPOINTMENT DATE Mft�N 101 -LOC)d TIME 00/065 <br /> (Please give 7 to 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS MAA - <br /> SIGNATURE OFAPPLICANT���Lvn<� I �[1 JJ� DATE03 -71 <br /> 00 <br /> FILE ADDRESS D <br /> ItJ 5rz�c.VLT"L�r.l <br /> V SW tF\- Qij%PuNr giEjk 5W tFT !T Tal P�\aa uNj &V 611:S 2000 <br /> �TtS St>rrLL W Lo. W <br /> V COt-OMF30IR1SGANA 144 5.L%0eet.W tWLr — O <br /> v '>`MFGvu - Mlo r' ZAc- FAR.*4 IIII tJAVY VatVe ebz <br /> DE'�O -ti•'(j,UC.1C570P IeOt o� loy N r2--c'�. O <br /> v TRAn15 w <,�Io.1 5rz7lt-'515 W. GN+� <br /> v OME•L tA.f I D ST CU. c(' W. Cv, NR (� <br /> Z N ��srD rrz n .V— T 025 NAV_Y ORaVC <br /> ENVIRONMENTAL HEALTH DIVISION FILES v , <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> IQ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ® UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <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 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 will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. *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 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01MWOa <br />