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11/10/2066 12:�f42 209-57025 IIODESTO ATC PAGE 02 <br /> -_. '�t j .iu.��� 59 "'9' 5 P.He <br /> SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES <br /> NOV 10 ZOOO 304ATVV ENTAL UELTH IFION <br /> ESSER AVN ,THIRD LOOR <br /> NMENT HEALTH STOCKTON CA 95202 <br /> ENVIRO <br /> PER NMENR ES (209)468.3420 <br /> !A PUBLIC RECORDS RELEASE APPLICATION <br /> A� VIA EUSINESS / 1 ` <br /> /AGENCY� , �SV O"Id <br /> A LIF` T �y\ r ^^ <br /> Z-Z--t FACSIMILE — <br /> r" <br /> TEN APPOINTMENT DATE 1v RF Y l �` TIME <br /> (Please glve 7 to 10 bas ; daga from Qaie of apVllUtion suemillAl) <br /> { <br /> Y-� CiuNECK BOX TO EXPEDITE REQUEST.$78.00 F1E�-REQUEST <br /> IP Ce ED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT �1`N"� <br /> VOv Jt"r-- DATE I.11,ta`Od <br /> FILE ADDRESS <br /> 1 m-1'•-tn C��..�cy 5'rrt.e.fi. SI-cc..tClo.n �..�. �2.4� /till. <br /> 4l W. C ✓I<✓ a 4vcIL4c� � .-L R_ u <br /> lsj' C.lnaar\-c✓ U�w S lK-Fo� J'�,7,.`, '. <br /> Iy.Z .��-'�. c. 1 Si-✓L+la S ),oClc�n ---t- _'��.3-l��� - _ <br /> S Wert CIAO✓ Wa t, 5+��io , T.- 22 �P` 4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP 51TE(LOP) G HOUSING ABATEMENT ❑ SOLID WA5TE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY in SOLIO WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAU ❑ DOG KENNEL ❑ DAIRY <br /> J HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PUNT <br /> ❑ TIERED PERMITTED FACIUTY O MOTELIHOTEL O PUMPER TROCK/YARDICHEM TOILETS <br /> 7 TATTOUBODY PEIRCING 0 POpUSPA O LAND USE APPLICATION SITES <br /> L7 MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY A80VE) <br /> 1. List up to tan addresses In the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(ea). At least one file type MUST be selected. FAX to(20,9) 464.0138 or mall 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 (1 D) days after receipt of application. The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> A file that is actively being worked an by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is avallobie. <br /> 4. Any file not returned in the sane 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 $78.00 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 /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> tl� 0� it 01ASOp <br /> TOTAL P.02 <br />