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U2 <br />ji02 09:45 CE"GS ASSOCIATES, INC. j 12094640138 <br />,E RECEIVED <br />26 W II: Do <br />N0.400 <br />�`,I-I; <br />r <br />,( <br />26 W II: Do <br />5AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION. <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468v-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />a <br />APPLICANT DOL A(j � } _ BU SINESSIAGENC,Y� `�'' �� ✓ &0jC " <br />ADDRESS 5 303 '-s`1�^\e'4c'Lt5to —} <br />SHONE -a-tiL'I'3'It FAGSIMILE <br />TNTATIV Ew APPOINTMENT DATE - TIME, <br />E <br />yi (Please gry 7 t#010 uomess ays fro dato os <br />/f ag�plimtlon ubmittal) <br />JExPEDRE REQllEST- PR 6D IN\t�sfRA DAY$ <br />CHECIt Boxio ,-40F <br />� � <br />SIGNATURE OF APPLICANT��t `�T DATE �W �Z <br />PRDGRAM <br />ENVIRONMENTAL HEAI.TM PIV1510N FILES0 Sou <br />GNDERGROUNb TANK Ns'rl CLEANUP SITE (LOP) CJ HOUSING ABATEMENT ❑ SOLI <br />D WASTE VEHICLE <br />OTHER CLEANIUP SITE (NOWLOP) ❑ FbQD FACILITY p DAIRY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL ❑ PKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR t7 CHICKEN RANCH A. <br />TIERED PERMITTED FACILITY M MOTEIIHOTEL ❑ PUMPERT APFUCALT*N$rMTOIL.ETS <br />❑ POOtJSPA � ❑ LAND USE APPLICATk)N $rfES <br />TATTOOIBODY PEIRCINe rt PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVEI <br />MEDICAL WASTE FACILITY <br />ypes) 01 flies from the list shove by checking <br />List up to ten addresses in the space above. Select the t <br />the appropriate box(es). At least one file type MUST be selected, Fax to (209) 454.0738or mail to the <br />address inoicated a oye. <br />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 />A file that is actively being worked on by END staff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />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 $76.00 deposit prior to review. <br />•TENTATIVE appointment dates must be confirmed With EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />�II2MED APPOINTMENT t)ATE TIME <br />CONFIRMED _ Pfi.ONE FAX INITIALS <br />lucn YPR NO REVIEW DATE _ <br />TOTAL P.02 <br />N0.400 <br />5AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION. <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468v-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />a <br />APPLICANT DOL A(j � } _ BU SINESSIAGENC,Y� `�'' �� ✓ &0jC " <br />ADDRESS 5 303 '-s`1�^\e'4c'Lt5to —} <br />SHONE -a-tiL'I'3'It FAGSIMILE <br />TNTATIV Ew APPOINTMENT DATE - TIME, <br />E <br />yi (Please gry 7 t#010 uomess ays fro dato os <br />/f ag�plimtlon ubmittal) <br />JExPEDRE REQllEST- PR 6D IN\t�sfRA DAY$ <br />CHECIt Boxio ,-40F <br />� � <br />SIGNATURE OF APPLICANT��t `�T DATE �W �Z <br />PRDGRAM <br />ENVIRONMENTAL HEAI.TM PIV1510N FILES0 Sou <br />GNDERGROUNb TANK Ns'rl CLEANUP SITE (LOP) CJ HOUSING ABATEMENT ❑ SOLI <br />D WASTE VEHICLE <br />OTHER CLEANIUP SITE (NOWLOP) ❑ FbQD FACILITY p DAIRY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL ❑ PKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR t7 CHICKEN RANCH A. <br />TIERED PERMITTED FACILITY M MOTEIIHOTEL ❑ PUMPERT APFUCALT*N$rMTOIL.ETS <br />❑ POOtJSPA � ❑ LAND USE APPLICATk)N $rfES <br />TATTOOIBODY PEIRCINe rt PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVEI <br />MEDICAL WASTE FACILITY <br />ypes) 01 flies from the list shove by checking <br />List up to ten addresses in the space above. Select the t <br />the appropriate box(es). At least one file type MUST be selected, Fax to (209) 454.0738or mail to the <br />address inoicated a oye. <br />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 />A file that is actively being worked on by END staff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />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 $76.00 deposit prior to review. <br />•TENTATIVE appointment dates must be confirmed With EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />�II2MED APPOINTMENT t)ATE TIME <br />CONFIRMED _ Pfi.ONE FAX INITIALS <br />lucn YPR NO REVIEW DATE _ <br />TOTAL P.02 <br />