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! SAN JOAQUIN COUNTYPUBLIC 1-IEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA b5202 <br /> (209)468-3420 <br /> PUBLIO RECORDS RELEASE APPLICATION_ _ <br /> APPLICANT BUSINESS( <br /> �G_FNCY <br /> nq <br /> ADOR S Yl;. s— L\n 5 <br /> PHON� �! ' FACSIMILE <br /> TENTATIVE-aPPaIN(TPMleesNT7lo nme <br /> ` 0 <br /> ciwoTE -y6 <br /> JJJ <br /> 10u lne�s da ran date 0(ODPIIwVM subinitWl) �• <br /> D <br /> U�JirS � 3 <br /> CHECK 80X TO,Ex[�EDITE ItE T .DO F E-REQUEST PROCESS 1N a BUSINESS DAYS <br /> C.� l �nm <br /> SIGNATURE OF APPLICA!, i �As�l DATE 1 2` <br /> Fad ADDRESS THIS SIDE EHD STAFF USL•ONLY <br /> i PROGRAM e'LEMENTS SEARCH <br /> 1 <br /> SEP 2 <br /> nn, <br /> _.. W <br /> O <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> W UNDERGROUND TANR JUST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Of SOLID WASTE FACILITY <br /> W OTHt R CLEANUP srrr(NON-LOP) O MO FACILITY ❑ SOLID WASTE VEHICLE <br /> C(I UNDERGROUND TANK(MON)TORINGfREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZAAMOUSWASTE GENERATOR t ❑ CHICKEN RANCH O PKGTREATMENTPLANT <br /> TIERED PERMI7T�D PAC1LnY ❑ MOTI!UHOTEL O PUIIPEH TRUCK/YARDICHL-M'rOILETS <br /> b TArrboiuOOY PHIRCING i ❑ POOLISPA "" ❑ LAND USE APPLICATION SITES <br /> o MZOICAL WASTL r-ACIUTY 13 PUDUC WATER SYSTEM ❑ OTHER{PLEASE 6PECIFY ABOVE) . <br /> 9. list up to ten addresses in the space above. Select the type(a)of files from the flat above by checking <br /> the appropriate box(es). At least one file type MUST be solocted. Fax to(209) 4640138 or mall to the <br /> address Indicated abovo.,, <br /> 2. EHD will cotify the applicint if any EHD files exlsL An appointment for review will be confirmed <br /> approxirAiely five business days but no later than ten (10)days afterreccipt of application. The files <br /> will be heldfor a maximurh of five businoss days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively boin q worked on by EHD staff may not be immediately available for review. A now <br /> application.may be subrhl"d when,the file is available. <br /> 4. Any Me not returned in Cha same condition as released will be reorganized by EHD Staff at the expense <br /> of,the applicant. Futuro fl}*rcvlews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. *TENTATIVE appointmentidatps must ba confirmed with EHD staff. <br /> 6 Applications received aftch 3:00 pm will be processed the ntxt business day. <br /> . . <br /> C ONORMED APPOINTMENT DALE TIME <br /> QATE QONFIRMED PHONE FAX INITIALS <br /> R@YIEVVED i n REVIEW DATE <br /> eceived Tine-Sea •2�0•- 2:56PM =---. - -• <br />