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No14:08 FAX 209 948 0 KLEINFELDER 1 U002/002 <br /> OATS RE':V-ED EHO LOG NUM ER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 017ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION j <br /> APPLICANT _ 5:��� ,f vCo BUSINESSIAGENCY <br /> ADDRESS— C4// qq • <br /> PHONE 94l,- jSf FACSIMILE —O 2 I — LOO <br /> TENTATIVE"APPOINTMENT DATE a Zia— 10-2- TIME Jl Oa <br /> (Please give 7 to 10 business da]Lfrom d e of application submittal) <br /> NN �}�'✓� i <br /> CHECK BOX TO EXPEDITE REQUEST-$87.O�EEs—REQUEST PROC AN4USINESS DAYS <br /> SIGNATURE OF APPLICANTDATE G� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> / PROGRAM ELEMENTS SEARCH <br /> ✓ Dei;c-_4-o ID-001 s M � W -4- p <br /> rr <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> i <br /> ❑'UNDERGROUND TANK(USTI CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> `OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEgHICLE <br /> ,_)2'UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY I <br /> __J7—HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKU TREATMENT]PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKMARDIOHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ' ' ❑ LAND USE APPLIOATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the listiabove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax 464.0138 or mail to the <br /> 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 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 EHDIStaff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 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 /> I <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE j <br /> cum ,t nwM)MII <br />