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V only JOAQUIN CUUN i YPUBLIC HEALTH SER%fICES <br /> E 1RONMENTAL HEALTH DIVISION <br /> )I i 3,rEAST W£SER AVENUE,THIRD FLOOR ;TF7 , f <br /> STOCKTON CA 95202 lX <br /> (209)468-3420 <br /> ,�//- I -' <br /> PUBLIC PECORDS RELEASE APPLICATION (' 1 <br /> V(APPLICANT �-1P f+� L _BUSIHESSIAGENCY 1 -fE.r Tr �. pT l T OKEC ��SfOylLQS <br /> I A f <br /> ADDRESS ! U1f7 Lr Cf 5�Z C.�n t'rp i <br /> PHONE I f �- 5 3'] C� . FACSIMILE <br /> Ci. 11 <br /> ;TENTATIVE`APPOINTMENT DATE TIME ; Q p n , <br /> (Pieper give <br /> 7-7.-I g pw;nt5s gays from dale Wapp►cation submittm)o '— <br /> I <br /> CHEC)G BOX TO FXPEDITE REQUEST-SAy.00 FEE-REQUE3T PROSESSED IN 3 BUSINESS DAYS J <br /> ^SIGNATURE OF APPLICANT (-J/ DATE <br /> FILE ADDRESS <br /> THIS SIDE EHL STAFF USE ONLY O <br /> PROGRAM EEF_atENTS SEARCN <br /> fl c. k nS 2 <br /> ENVIRONMENTAL HEALTH DIVISION FILES 'IT 2 9 2001 <br /> UNDERTOUNDTANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT C) SOCIO W/u^7E PANICKY <br /> R IINOERGRDLND TANK OTHER LFANUP 567E(NON-LOP) ❑ FOOD FACILITY <br /> (MONtTOR1NWAEMOVAL) CI DOG KENNEL ❑ SOCIO WASTE VEHICLE1R ❑ DAIRY <br /> • <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENTPLANT <br /> ❑ TIERED h ODY PEp PANICKY O PUMPER TRuCKr'(ARD/CHEM TOILaYS <br /> � Q M07r_1,JHOTEL <br /> ❑ MEDICAL' <br /> WASTE <br /> I: CING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAU WASTE FACIul'Y <br /> I C1PUBLIC WATER SYSTpM ❑ OTHER(PLEASE SPECIFYADDVE) <br /> ' <br /> t. Dist up to ten addrasses in the space above. Select the types) of files from the list above by checking <br /> trig appropriate box(es). Af least One file type MUST be selected. Fax 209 <br /> address indicated above i38 or mail fie <br /> 2• END will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> 0pfiroximately five business clays but no later than ten (10)days after receipt of application. The files <br /> 7ccbe held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3• file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> ppl)catiun may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized <br /> 5• ofdf the applicant Future file reviews b by EHD staff at the expense <br /> th aPplic appointment y the same applicant may require a$87.00 deposit prior to review. <br /> G. Applications received after 3;00 pm will bbe confirmed <br /> Irtocceessed henDtbus <br /> i P next business day. <br /> I . <br /> CONRRMEp APPOINTMENT DATE <br /> TIME <br /> DATE=CONFIRMED PHONE FAX <br /> INITIALS <br /> REVtEWEf� � <br /> YES <br /> EH w ++ oaoawo i NO REVIEW DATE <br /> TOTAL P.H2 <br />