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14�P L�p . : 53P Krazar d Assoc 559 3 2190 P - 01 <br /> DATE RECEIYEO <br /> EHD 400 Nume" <br /> = _ '2 SAN JOAQUIN COUNTYPUSLIC HEALTH SERVIGtS <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> „ i r dI�FS STOCKTONON A95202 <br /> (204)4+58-3-3 420 <br /> PUBLIC RECORDS RELEASE APPLICATION r III, <br /> APPLICANT—70 0 -R' BUSINESSIAGENCY AZf3 r�r7 y. <br /> ADDRESS /\\ Ih t19 <br /> PHONE�5�1 �4 -�"t� FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE 1 101,r TIME <br /> � <br /> (/ (Please 111"7 to 10 business from dale of application submittal) <br /> OCHECK BOX TO EXPEDITE REQUEST .0 EST PROCESSED IN 3 BUSINESS DAYS ,r <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Jill C'I Et - e <br /> u.) 'I LIST M � <br /> CLASr <br /> ENVIRONMENTAL HEALTH DIVISION FILES >,* <br /> -14 UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) D HOUSING ABATEMENT CO SOLID WASTE FACILITY <br /> T"1 OTHER CLEANUP SITE(NON-LOP) U FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> -".UNDERGROUND TANK(MONITORINWREMOVAL) ❑ DOG KENNEL O DAIRY <br /> 1;f.LHAZARDOUS WASTE GENERATOR 4 CHICKEN RANCH ❑ PKG TREATMENT PLANT _ <br /> 171 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOI]LETS <br /> G TATTOOIBODY PEIRCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILr1Y ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types)of files front the list above by checking <br /> the appropriate box(es). At least one file"MUST be selected. Fax to(209) 464-0138 or_mall 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(f D)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 he submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHO staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a$89.00 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 /> I <br /> Fr71RMED APPOINTMENT DATE TIME <br /> CONFIRMED PHONE FAX INITIALS <br /> REVIEIVED YES NO REVIEW DATE <br /> �— <br /> nm-nn <br /> EE-11-2902 MON 10:51AM ID:KRRZAN AND ASSOC PAGE:1 <br />