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-Ia�">QH0 1029t;M ]M TO 15592687126 P.O: <br /> a-rnre,:cer a� "" owLOG.rauue <br /> D �l\U D� SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES I <br /> Il v ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ANa 1 4 20�� STOCKTON CA 95202 <br /> EALTH (las)4611-3420 <br /> ENI ENT H <br /> PUBLICRECORDSRELEASE APPLICATION <br /> PE� L CANT `d� (Ytu�y_ SUUSWCSBIAGENCY <br /> ADURES9 "c4rJp�o�.� p��Y�J�Yt'1 ST\•OQy\ ��OSf1C�5.�. Q UI ��.� f _ <br /> SHONE '.'S-J I 7�� (y /�2.I FACSIMILE <br /> _ i` TENTATIVE"APPOIN rNENT RATE IL TIME )i(:> r.... <br /> Y (Please give 7 la 10 4uairPlba day5lrom date Of APP41caum submittal) <br /> CHECK BOXTO EXPEDITE REQUEST-$87.00 FEE-REQUFST PRO(ZSSE01N 3 UUSIMESS DAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> FILE ADDRE45 THIS SIDE END STAFF USE ONLY <br /> C'. .r Kce.. PROGRAM ELEMENTS SEARCLt <br /> ) 1 <br /> \��r N---- � a s 1 d t • �c o 04 2 � ,v <br /> P 1dLIS <br /> L) o / l Ccs li✓'(V (J, 7� c >> 7 <br /> N U vCHI, 2Z2C <br /> Tc t= ;- I i �! -> <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X UNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLD WASTE FACILITY <br /> Z5OTHER CLEANUP SITE(NON4.OP) 0 FOOD FACA M 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONFrORINGIREMOVAL) 0 DOG KENNEL. 0 DAIRY <br /> )K HAZAROQUs WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREA'IIIENT PLANT <br /> P TIERED PERMITTED FACILRY 0 MOTELWOTEL O PUMPER TRUCK/YAHWCHEM TOa.ETU <br /> O TAT'TOMBODY PEIRCING 0 POOLISPA O LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOYF4 <br /> 1. List up to ten addresses In the space above. Select the type(s) of fit(*from the list above by checking <br /> the appropriate box(es). At least one File type MUST be selected. Eggto 2011 136 or mall to the <br /> address 1 is <br /> above- <br /> 2, EHO will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> i 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 /> a. A file that is actively being worked on by EHD ftaff may not be immediately available for review. A new <br /> application may be submitted when the file is aVallable. <br /> A. Any file not returned In the same condltien as released will be reorganized by EHD staff at the expense <br /> of the applicant Futuro file reviews by the came applicant may require a$87.00 deposit prior to roviaw. <br /> 3. "TENTATIVE appointment dates must be confirmed with END staff. <br /> �. Applications received after 3:00 pm will be processed the next business day, <br /> i <br /> I{,, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED ,PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ivi ro Q M070 <br /> TOTI4- P.01 <br />