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9AM; IT/EMC0N ;916 928 3341 # I/ I <br /> R <br /> V > 4640130 ENVIRONMENTAL HEA RE <br /> OATZ PGCFIV6y' flUYe <br /> 3 SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 1P <br /> NVI MENTAL HEALTH <br /> DIVISION, <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCTON CA 95202 <br /> 937 <br /> 02 Ii' Y - I P 3: 19 <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT [t A>lln v/2n 'fir Xis-. g,.J BUSINESSIAOENCY /T 6-P-002 . <br /> ADDRESS 15Z6 <br /> PHONE FACSIMILE 91E <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Plaase���hus7n�daycAda`Ste�pllnllen submittal) AY - <br /> T goo' <br /> CHECK BOX TO EXPEDITE REQUES 589.0 F E-RE EST E40 1 3 BUSINESS DAYS J <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY 0PROGRAM ELEMENTS SEARCH <br /> s � N <br /> YC <br /> 0 2 z <br /> + 0D <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 14 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) M DOG KENNEL ❑ DAIRY <br /> ❑ HAYARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTFL ❑ PUMPER TRUCKIYARWCHEM TOILETS <br /> ❑ TATTOOTBODY PErRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O 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 Selectet�Fax to (209)464-0138 or mail to the <br /> address Indicated above. C <br /> 2. EHD will notify the applicant if any EHD files ex(st 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 EHD staff may not be Immediately available for review. A now <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$89.00 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 />