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_1 x� �V VV 11 �l1-511 <br /> :� Eµn Jnr,rruME3lµ <br /> oAT t FFCEiveo <br /># SAN JOAN COUNTYPUBLIC HEALTH SE�ICES <br /> ENVIRONMENTAL HEALTH DIVISION (lo <br /> 304 EAST WE13ER AVENUE,THIRD FLOOR- i- e <br /> I STOCKTON CA 95202 <br /> L" <br /> i�� 1#�t r • f,,.�.__ <br /> a <br /> { Y -� tq <br /> (209) 4fi8-3x20 � 1. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT I-b+���� r BUSINESSIAGENCY <br /> — <br /> 177r1-11 -C'S <br /> ADDRESS q' <br /> PHONE — FACSIMILE D `r <br />� ';TIME <br /> TENTATIVE' APPOINTMENT DATE co <br /> (Please give 7 to 0 bus�nass d ys from date of appliration submittal) <br /> f <br /> CHECK BOX TO EXPEDITE REQUEST-$7 0 FEE-REQUEST P ESSED IN 3 BI}$[NESS L1AYS <br /> i DATE <br /> IIGNATURE OF APPLICANT it <br /> .i <br /> FILE ADDi7ESS ' <br /> y3 #t)c , <br /> -75 G (1yc ct.�Chu rDL �, <br /> el <br /> �• • ,. ��.1 <br /> a 5 log-96* <br /> -] Ju (D 1'1 <br /> .I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> KSOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 6 FOOD FACILITY ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) g DOG KENNEL fl PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR fl CHICKEN RANCH fl PUMPER TRUCIVYAi2D1CHt:M TDILETS <br /> TiERER PERMITTED FACILrrY ❑ MOTEIJHOTEL <br /> i? ❑ LAND USE APPLICATION SITES <br /> p TATTOOIBODY PEIRCING ❑ pOpUSPA ❑ OTHER(PLEASE SPECIFY ABOVE) ) <br /> ❑ MEDICAL WASTE FACILITY d f USLIC WATER SYSTEM <br /> i <br /> y <br /> 1. List up to ten addresses in the space above. Select the type{s) of pFax from the list above b checking I <br /> the appropriate box(es). At least one file type MUST be selected- ;,Fax to (2093 464-0138 or mail to thg <br /> addrers Indicated above ji <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> r than ten (10) days after receipt of application. The flies <br /> approximately five business days but no late <br /> ays for reviewy Appointments should be scheduled <br /> will be held for a maximum of five business d <br /> accordingly. 1 <br /> 3, A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. i) <br /> 4. Any file not returned in the same condition as released willlhe reorganized <br /> $78 0 deposit t priorto review. <br /> of the applicant. Future file roviews by the same applicant.may q 'I ' <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> f <br /> CONFIRMED APPOINTMENT DATE 1[1AE <br /> DATE CONFIRMED PHONE ii FAX INITIALS <br /> It i <br /> REVIEWED YES NO REVIEW DATE f <br /> i <br /> ets ov 1* —.— ( � 1 + r 1 <br /> (A-++ `T TOTR� P.02 1 <br /> 7�� 7 <br />