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SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />EN 20NMENTAL HEALTH DIVISION <br />304-eAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION r <br />APPLICANT ?0IZt6L 0J BUSINESS/AGENCY MhALL AICLOI mti- [A") <br />ADDRESS 24C3 GOND Cft*L. <br />PHONE 0. �*j-+11-3Y33 FACSIMILE 2-01-413_4"I(1 <br />TENTATIVE' APPOINTMENT DATE J4+j • a-3 1 1006 TIME 10 WA <br />(Please give 7 to 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST C <br />8.0 E - REQU T PROCESSED IN 3 BUSINESS DAYS recelyed <br />SIGNATURE OF APPLICANT DATE <br />ADDRESS1507- FILE <br />U" <br />SrRf1� <br />ENVIRONMENTAL HEALTH DIVISION FILES V VNNU ISLE' O <br />L'� <br />a/ NDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />CLEANUP SITE (NON -LOP) <br />U" <br />SrRf1� <br />ENVIRONMENTAL HEALTH DIVISION FILES V VNNU ISLE' O <br />L'� <br />a/ NDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />CLEANUP SITE (NON -LOP) <br />❑ <br />FOOD FACILITY <br />❑ SOLID WASTE VEHICLE J� � ? ,� 2000 <br />U:"UCTHER <br />NDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ <br />DOG KENNEL <br />❑ DAIRY <br />2 HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ <br />MOTELIHOTEL <br />��❑���/////,,,fffPPPPP'UMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOIBODY PEIRCING <br />❑ <br />POOLISPA <br />ND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ <br />PUBLIC WATER SYSTEM <br />Qf 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 (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 $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 />EX 00 14 01105100 <br />