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i <br />w* £0'30138 '1ti101 w.e <br />lac-L7-ennL aa: JLHI'� rrtln v TD 8431800 P.01 <br />7 '' " SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ...,_ <br />Et VIRONMENTAL HEALTH DIVISION • <br />AUG 1 3 ZUU1 3q4 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209)4083420 <br />7 PUBLIC ',RECORDS RELEASEAPPLICATION <br />�A?PL(CANT TSE �-. �o �YLC'012Z 13USINESSIAGENCY <br />ADDRESS <br />F 1OIVE <br />L <br />IN <br />TENYATIVE' APPQINTMENT DATE_ TIME <br />: (Plaasa 9'�se 7to 10 businoss tlaTys<from dazm daaP�donsWmttWl <br />CHECK 8OX TO EXPEDITE REQUEST• S8I:00 FEE-REQV6ST PROCESSFy IN 3 DUSINE5S DAV$ <br />-SIGNATURE OF APPLICANT �� 2=,� nc� -C� DATE <br />�eF 1USIE:bNLY <br />PROGRAM <br />■■ <br />f .� � � � � � IIIIIIIIIIIII■ IIIIIIIIIIIII■IIIIIIIIIIIII'Illll� <br />Vr' ,Y>I �� � •r O <br />to 1 � �rI_��IIIIIIIIIIII�IIIIIIIIIIIII�' <br />�� � • � IIIIIIIIIIII{�:11111111111��- <br />. film <br />FROM <br />O <br />•_ <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HCU$ING ADATEMEHT a SOLID WASTp FACILITY <br />OTHER CLEANUP $ITE (NON -LDP) D FOOD FACUX-Y 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK(MONITORWGfREMDvAL) 0 DOG KENNEL C DAIRY <br />G HAZARDOUS WASTE GENErtATOR - cl CHICKEN RANCH 0 PKG TREATMENT PLANT' <br />G TIEREO PERMI TED FACILITY O MOTEVHOTEL ❑ PUMPER TRUCKIYARDiCHEM TOILETS <br />D 14TTOOMODYPEIRCING - 0 POOUSPA - ' Ll LAND USE APPLICATION SITES <br />C MEDICALvYASTEFACILrtY 0 PUHUC WATER SYSTEM O OTHER (PLEASE SPECIFY AOOY4) <br />List up to ten addresses in the space above, Select the type(S) of tiles from the list above by checking <br />the appropriate boX(es). At least one file type MUST be selected. Fax 209 464-01M or mail to tho <br />addross indicated above. <br />2. EHD will notffy the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days atter receipt of application. The files <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. .A file that is actively boino worked on by 6HD staff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition a$ released will be reorganized by EHD staff at the expense <br />Of the applicant. Future file reviews by the same applicant may require a $$7.00 deposit prior to review. <br />5. `TENTATIVE appointment dates must be confirmed with EMO staff. <br />61 Application* received after 3:00 Pm will be Processed the next business day.. <br />�C(Nt ttlMttl APPOINTMENT DATE <br />DATE CONFIRMED <br />No <br />TIME <br />PHONE FAX INITIALS <br />TOTAL <br />£0/£0'd 8£L0ti9G£LJZT6 01 GS8T 96L 606 3 -1113d1 -I LIJINOW 1d TS:l, T0. £T snu <br />