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UHl l hL1.Ll.lu <br /> hHU LOU IrUMib Lk <br /> SAN JOAQUIN COUNTY Ah <br /> E;. RONMENTAL HEALTH DEPART TENT <br /> 304 EAST WEBER AVENUE, THIRD FLOOR I <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSIIN�ESSSIIA"G'E"N"CY 1 "� 4~�t'I CK C.19 <br /> ADDRESS .p 2— �/-1-U c.grvw��/`�,(�� �, 475g/ -z— <br /> PHONE <br /> PHONE — 1 /C7 /T(p S� FACSIMILE 9)6 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> P' C �� <br /> (/ Y <br /> HECK BOX TO EXPEDITE REQUEST-$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS 31 <br /> I <br /> SIGNATURE OF APPLICANT _ y DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 0 oR-?f+- rNcr,Q dL r�r`vu�E <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> e7�NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Q(OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> CY UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Ur TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ OL/SPA /l, LAND USE APPLICATIO SITES <br /> E3OT <br /> MEDICAL WASTE FACILITY m HER(PLEASE SPECIFY) �_�e! j—+ L 9-Y§ 'rke-*M .5 <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. Fax to (209)464-0138 or 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 being 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$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. �y''v,�'f! r� <br /> "s_. <br /> ih <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4"244 <br /> W2612Hs <br />