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209 9480621 10 002 <br /> ....,LOG NUMBER <br /> SAN JOAQUI•OUNTYPUBLIC HEALTH SERVIC9 <br /> ENVIRONMENTAL HEALTH DIVISION rqq <br /> 304 EAST yyE13ER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ��11� YTNQ��. - BUSNrSSIAGENCY I2,, tAFfA- 9� <br /> ADDRESS <br /> PHONE FACSIMILE <br /> TENTATIVE*A OINTMENT DATE Il b TiME Y' OtJ Pr^ <br /> (P gale 7 ta�0 h ne55 da date « " ons I ) - <br /> N <br /> 0 CHEGKBOXTOLXPLUITE. S -SO 0 QUEST IN7 ESS <br /> SIGNATURE OF APPLICANT DATE y d Z <br /> FILE ADDRESS THIS 510E EHL STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> e r <br /> ENVIRONMENTAL HEALTH DIV ION FILES <br /> / ❑ HOUSING ABATEMENr� 0I SOLID WASTE FACILITY <br /> ¢ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY XC3 <br /> SOLID WASTE VEHICLE <br /> Q OTHER CLEANUP SITE(NON�OP) IRYUNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG NEL GTREATMENTPLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CNICT�N RANCH❑ TIERED PERMITTED FA ILI TY ❑ rdOTEIJHOTEL .,. MPER TRUCKIYARDICHEM TOILETS, <br /> 0 TATTOOISODYPEIRCING ❑'POOLrSPA - ND USE APPLICATION SM <br /> ❑ MEDICAL WASTE FACILITY � PUBLIC WATER SYSTEMHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(sfrom the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. FaX to 209 464.013 or ail o 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 <br /> receipt <br /> Of applishould cation. <br /> led files <br /> Will be held for a maximum of five business days for review. App e <br /> accordingly. A new <br /> 3. A file that Is actively <br /> being worked on by EHD staff may not be immediately available for review <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganlzad'by EHD staff 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 /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO - REVIEW DATE <br />