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--ab , Iy • L6 z uI-m �vV,Oh LtY i1 IEG6uLUGiLJ 0 _ <br /> GATE IjEC.E1VED F11DL n,A <br /> SAN JOAZ�UIN COUNTYPUBLIG HEALTH SERVICES e �� <br /> ENVIRONMENTAL. HEALTft�'flt�l <br /> rr 7 <br /> 304 EAST WEBER AVENUE,TH RD ' • O)z t <br /> STOCKTON CA 9520'' ,- <br /> (209)468-3420 �y7 <br /> KUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Magi k(.� 5 BUSINESS/AGENCY Co"'tcy' t= r-tk 4-.�ko (o jos -rnC• <br /> ADDRESSC-A 952(n <br /> 18PA Frank Wz� t �iV cl4 .t �a T <br /> PHONE 2.01 ^ 2 3 » Os t 8 FACSIMILE 2 o't - z 3 _ rn 5'a 6' <br /> TENTATIVE'APPOINTMENT DATE TIME - <br /> (Please give 7 tot business Clays from data o epplic tlon sub Iftal) <br /> MEGK BOX TO EXPEDITE REQUEST-$87.00 F -KECiIfE� I&�4y^iF <br /> SIGNATURE OF APPLICANT DATE 00 Z,. <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> � �1 3� 5. A; r o•r-t' VJ 5�val,��e-1n <br /> I55 � wol.tn. :al Dr. <br /> 1 b l D LCZ <br /> .D X1.3 $ • .4i r o i'. tt_7 • <br /> l l . i r <br /> q s . A-i tr t (A3 <br /> -6(-2, 4 Ai 0-V-V u_� <br /> /tri r ar LO <br /> ENVIRONMENTAL HEALTH DIVISION FIDS <br /> L7yNDERCROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Or SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ ,SOIJD WASTE VEHICLE <br /> d UNDERGROUND TANK(MONITORINGIREMOVAL) ❑j1OG KENNEL _ e'DAIRY <br /> I�HAZARDOUS WASTE GENERATOR CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEL/HOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/sm `• Q LAND USE APPLICATION SITES <br /> ❑ 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 list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. FgX to (209) 464 0138 ar 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 bring worked on by EHD 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 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 />