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FROM Ge it In FAX NO. : 2095690295 <br />'\VliL KLA 1LIVPD <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES �UG 0 1 200Z <br />ENVIRONMENTAL. HEALTH DIVISION / <br />304 EAST WEBER AVENUE, THIRD FLOOR ENVIRONMENT HEALTH <br />T STOCKTON CA 95202 PER <br />VIUS <br />209 468 3420 , <br />( ) N � ; <br />PUBLIC RECORDS RELEASE APP <br />LICATfO <br />v� <br />y' BUSINESSIAGENCY • q�� `��4 "� �r ~ r4� <br />APPLICANT ;4-- <br />ADDRESS <br />PHONE r_ _ — FAdSIMILE <br />TENTATIVE* APPOINTMENT DATE <br />(Please plve 7 to <br />CHECK BOX TO EXPEDITE REQUEST - $89.00 FEE– REQUEST PROCESSED IN 3 B <br />submittal) <br />Z:�Z� <br />SIGNATURE OF APPLICANT <br />I ^K11 V AIN <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />M HOUSING ABATEMENT CISOLID WASTE rACILITY <br />UNDERGROUND.TANK (UST) CLEANUP SITE (LOP) O FOOD FACIL" 0 SOLID WASTE VEHICLE* <br />OTHER CLEANUP SITE (NON -LOP) 0 DOG KENNEL O DAIRY <br />UNDERGROUND TANK (MONITOR INGIREMOVAL) O CHICKEN RANCH 17 PKG TREATMENT PLANT <br />i4f HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL r3PUMPER TRUCK/YARDICHEM TOILETS <br />❑ TIERED PERMITTED FACILnY0 LAND usE APPLICATION SITES <br />O TATTOOIBQ pOOLISPA ODY PEIRCING 0PUBLIC WATER SYSTEM 0 OTHER (PLEASE SP>_CIFY ABOVE*) <br />0 MEDICAL WASTE !=AGILITY <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 filo type MUST be selected. Fax to 209 464-0138 or mail to the <br />r address indicated above. <br />2, EHD will notify the applicant if any EHO files exist. An app dais afteent r receipt of appli ation The files <br />approximately five business days but no later than ten ( D) Y <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3, A fife that.is actively being worked on by EHD staff may not be immediately available for review.._ new <br />application may be submitted when the file i5 available. <br />4. Any file not returned in the same Condition as released will be reorganized a $89.00 deposit prior to review.of the applicant. Future file reviews by the same applicant mayrequire <br />g- 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />G. 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 />-•n a 1 nor . <br />ry <br />