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��I. 2 .L L003 SAN JOAQUIN COUNTY <br /> ENONMENTAL HEALTH DEPART�T <br /> 4 EAST WEBER AVENUE, THIRD FLOG <br /> STOCKTON CA 95202 12 <br /> 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION `/ J <br /> ry nl.AlT • '1-� <br /> r <br /> APPLICANT_�:L/ C-F/13!, BUSINESS/AGENCY � ,. <br /> -�S /� � !���'/f'l <br /> ADDRESSL/ . Z,Z Z- - IL ,0!2 zo r .— <br /> PHONE FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) ' <br /> • <br /> CHECK BOX TO EXPEDITE REQUEST-$89.0 FEE—RE /EST PROC SED IN 5 BUSINESS DAYS <br /> Iq <br /> SIGNATURE OF APPLICANT'/= <br /> DATE ( ' / <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTSSEARCH (rrte, <br /> 29 <br /> w <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> /❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) /] FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> P UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> / HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY '❑ OTHER(PLEASE SPECIFY) <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 (209) 464-0138 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 $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 /> EDATE <br /> IRMED APPOINTMENT DATE TIME <br /> ONFIRMED PHONE FAX INITIALS <br /> WED YES NO REVIEW DATE <br /> EMD 4E-02-006 <br /> U2612003 <br />