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ENG LOG NUMBER/ <br /> aar6 aECe/Eo <br /> /SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 466-34202020 <br /> l PUBLIC RECORDS RELEASE APPLICATION <br /> �—PeTAPPLICANT_ <br /> 'ap-- ] �� ,E?, QBUSINESS/AGENCY iY�or.�L �F TIS _.,( <br /> Ci\ <br /> ADDRESS7� A AfJ No <br /> 3 -- <br /> 4A <br /> PHONE A- -FACSIMILE <br /> TE VTATIVE"APPOINTMENT DATE „ TIME <br /> ryl/ (Please give 71010 busineen d s lram dale of app1"c ]aubmhtal) <br /> r <br /> 1—I CNECK BOX TO EKPEDUF REQUES -°db, FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT ri V� t <br /> C-� <br /> ^PILI g1bRE59 Yam-f�( In'� <br /> Vtk ll "C — , <br /> -� � z a.ZqS I <br /> c <br /> it A l LL `�`�OTH pQflPE"R-r/ ....�YSZAC NV7 41" O V1C%Iav' Pelh <br /> tt <br /> it-ice u VACIV— <br /> C.owti.ncc rc <br /> t� •� u _ V t \ Mcx>1a A I <br /> La <br /> u u a t�.g cFaN c,omP tJ uta-T C'�7 -cft� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> TIT O SOLID WASTE FACILITY <br /> ❑ NDERGRCUN TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE VEHICLE <br /> CI"CHER CLEANUP SITE(NON-LOP) - ❑ FOOD FACILITY ❑ DAIRY <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ PKG TREATMENT PLANT <br /> ❑ HAZARGOLS WASTE GENERATOR ❑ CHICKEN RANCH Cl PUMPER TRUCK(YARWCHEM TOILETS <br /> ❑ TIERED PEHMITTED FACILITY P MOTELIHOTEL ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOMODY PEIRCING O POOUSPA ❑ OTHFR(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL YN ASTE FACILITY ❑ PUBLIC WATER SYSTEM <br /> 1. Lh;t Up to ten addresses in the space above. Select the type(s)of files from the list above by shacking <br /> thlr appropriate box(es). At (east one file type MUST be selected. -x to(209) 464.0138 or mail to the <br /> address Indic ehd ab'opve• y ointment for review will he cantirmed <br /> 2. Et'.D will noti thea licant if an EHD files exist. An app <br /> approximately five business days but no later than ten(10) days after receipt of application, The files <br /> wi I be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3, A'ile that is actively being worked on by END staff may not he immediately available for review. new <br /> application may be submitted when the file is available. <br /> 4. Ary file not returned in the same condition as released will be reorganized by END staff atthe expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> e confirmed with END staff. <br /> g. Applications appointment <br /> after 3:00 pm Will be processed the next business day. <br /> r <br /> ED APPOINTMENT DATE TIME <br /> FIRMED PHONE FAX INITIALS <br /> YES NO M REVIEW DATE <br /> EH Ce ii 0110 Q <br /> T9 391,1 ss3�=I�?3 NhII �'+%'.iZ-IOH 99,9S0S9E.0� 5b TO 090G!L9!�L <br />