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SAN JOAQUIN.COUNTYPUSLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DM£ N' <br /> u 1 ! 304 EAST WEBER AVENUE,THIRD FLOOD <br /> STOCKTON CA 95202 '�� <br /> JUL 11 (Lu1 (209) 4683420 <br /> tiTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANTJy` f ` �tinJ p.^!/w,�. BBU�SIINESS/AGENCY Q,[�yyapiclod <br /> p <br /> ADDRESS d3! <br /> PHONE <br /> TENTATIVE'APPOINTMENT DATE TIME rak's15 .9 <br /> (Plsaae sive 7 to i0 btieinass days from dam of APPIIcadon 6-13anal) U V L. . I I � <br /> ® Ll�t/iT5 3; <br /> CHECK BOX TO EXPLO E REQUEST-7a FEE-RFjqUESTPR0Cr3a4D IN 7 BUSINESS PATS �.-p <br /> SIGNATURE OF APPLICANT DATE d (t I <br /> FILE ADDRESS O <br /> .d <br /> VLO <br /> v 1 171 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOUL)WASTE FACILITY <br /> OTHER CLEANUP SITE(NONd.OP) ❑ FOOD FACIUTY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMO`7AL) Q DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANGH 13 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILI" ❑ MOTEUHOTEL ❑ PUMPER TRUCK/(ARDICHEM TOILETS <br /> ❑ TATTOOMODY PEIRCiNG ❑ POOLlSPA O LARD USE APPUCATION SITES <br /> ❑ MEUK:AL WASTE FACILITY ❑ PUSUC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses in the space above. Select the type(s)of flies from the list above by checking <br /> the appropriate box(es). At least one filo type MUST be selected. Fax to (209)464-0138 or mail to the <br /> addrQssindicated above. <br /> 2. EHL)4vill notify the applicant if any END files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of applicatiorf_ The files <br /> will be held for a maximum of rive business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3_ A file that is actively being worked on by END 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 END 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 END 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 /> Wmis 01n <br />