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10/-qf�002 11:12 ' <br /> _.09-5?9-2225 <br /> • � � M0DEST0 ATC PAGE 01 <br /> aSAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION �' <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 /O <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT J <br /> er� — <br /> ADDRESS (l r1 . L BUSINESS/AGENCY 1-f'. <br /> PHONE-(20,R ) s +�� Pto�t �C1 Ct1 <br /> - ZZz (2495 ) S _ <br /> FACSIMILE 5 <br /> TENTATIVE^APPOINTMENT DATE <br /> !v -RI - az N TH <br /> (Please Ui c 7 la 10 business TIME _/O�l-j PE���IT/SERVICES <br /> ❑ ' . /r n date o PplIcatlon submittal) <br /> CHOCK BOX TO,CXPEDITE REQUEST- 0 FCE- <br /> REq -ST PARSE <br /> SIGNATURE OFNJ 13USINESS DAYS <br /> ,APPLICANT <br /> 5;�I—X7 <br /> DATE /V— o2 <br /> FILE ADDRESS <br /> ^� THIS SIDE EHD STAFF U LS ONLY <br /> �+►1'eer /5 5 �1G vI �d S. P119GRAM ELEMENTS SEARCH <br /> Mor t• �f •�' Esq 1 h <br /> to c4 <br /> S c k <br /> S� + 2353 Tf� <br /> i Ceti t✓ T" -� <br /> Trac t; <br /> 41-11111, Tr N Z35Gv as ,� R �✓a <br /> (�M 425 1-a 4 f? TrcK V v <br /> 5. lo,ir Trutlt��� 350 Tr„c 8 v S. Tva V <br /> �vv e_ M <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST) CLEANUP SITELOP p <br /> OTHER CLEANUP SITE(NON-LOP) ( ) HOUSING ABATEMENT <br /> UNDERGROUND TANK(MONITORING/REMOVAL00 FOOD FACILITY 0 SOLID WASTE FACILITY <br /> O HAZARDOUS WASTE GENERATOR ) DOG KENNEL O SOLID WASTE VEHICLE <br /> O TIERED PERMIT-r-D F 0 CHICKEN RANCH 0 DAIRY <br /> O TATTOO/BODY PjjIRCINGLITY O MOTEUHOTEL 0 PKG TREATMENT PLANT <br /> MEDICAL WA5•re FACILITY O POOUSPA — 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> O PUBLIC WATER SYSTEM OO LAND USE APPLICATION SITES <br /> List up to ten addresses in 1110 space above. Select the type(s) of files from OTHER thelist aSE bove by <br /> the appropriate bOX(es). At (cast one file type MUST be se ected. Fax tf 209 a list a38 a m, i <br /> address•indicated hove, hove by checking <br /> 2. f ) iltothc <br /> EHD will notify the applicant if any EHD files exist. An appointment for review will be confit <br /> approximately five business days but no later than ten (10) days after receipt of application confirmed <br /> will be held for a maximum of five business days for review. Appointments should be Scheduled. Tho files <br /> a file that is actively bcin9 worked on by EHD staff may not be Immediatelyavails I�eduled <br /> application may be submitted when the file is available. <br /> • Any file not returned in clic same condition as released will be reorganized by EHD staffs review. Anew <br /> of the applicant. Future file reviews b <br /> "TENTATIVE a y the same a t the o rea 50 <br /> view. <br /> appointment dat05 must be confirmed with EHD astaff. uire a 587.00 deposit prior to review. <br /> Applications received after 3:00 Pm will be processed the next business day. <br /> ;ONFIRMED APPOINTMENT DATE <br /> ATE CONFIRMED TIME <br /> EVlE1NED <br /> PHONE- FAX INITIALS <br /> YES <br /> REVIEW DATE <br /> up <br />