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OAT N G IV • �O'V4 • EHIILM..NIIM- <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> III ENVIRONMENTAL HEALTH DIVISION - �V <br /> \ <br /> N 304 FAST WEBER AVENUE,THIRD FLOOR <br /> V �A M STOCKTON CA 95202 <br /> ��`^ (209)468-3420 <br /> S ` PUBLIC RECORDS RELEASE APPLICATION t _ <br /> APPLICANT PC'TE� a 1MODeF BUSINESSIAGENCYL— <br /> ADDRESS /R`U� <br /> PHONE��JCl��2'"T�'03-17 FACSIMILE ('30")12�—�2=-r <br /> TENTATIVE'APPOINTMENT DATE -fl�Z TIME • �� y"r'� <br /> -IJ�, ?, �� /� T,i[Please give 7 to 10 business dl�rs from <br /> �date of application submittal) <br /> ❑gCFi£CK�80A TO EXPEDITERyEQUEST-$7778.400 ME--REQUESTi- OCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> Sa FIARt fRN 2D �2kwctt Ga a9o_e <br /> - - <br /> \1 <br /> - <br /> '�-�03 <br /> �...\ -r.ot.� 7 a✓ G <br /> p � grocr�`coN <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 54/VNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 67/OTHER CLEAN UP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> S UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL IC PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ PDOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the typo(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to !2091464-0138 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 END 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE — <br /> EH 00 14 01MUM <br />