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a <br /> ', esu ux)Hut�nrat <br /> SAN JOAQUIN GQUNTYPUBLIC HEALTH S VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 FAST WESERAVENUE,THIRD FLOOR � ,] <br /> STOCKTON CA 95.202 <br /> (209)46a•3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCAN7C Tr <br /> t r a-.r R _ ,vslrla=AaPIcy P [b fz <br /> AL)DRESS S}J� T L o U t' VG 4t v7 C C <br /> !'HONE s7 FAC51NkILF_, <br /> TENTATIVE*APPP INTMENT DATE ' TIME <br /> maa da 6 from data of s kation submittal <br /> ease the T to 10 Jluxk� ) <br /> �i 9 Y Pp <br /> uvirs <br /> CHL CK BOX TO Exnprrc 116QUEST 07.00 FEE—REQU - Y PROCESSED IN 3 SUUMMS DAYS <br /> !l1SIGNATURE OF APPLICANT DATE <br /> FILE A93DRESS THIS SIDa EMATAFIF USE ONLY <br /> P130GRAMI ELEMENTS MARCH <br /> aU le ti -- <br /> p C' • o t. T <br /> p L __.. <br /> O O F, <br /> S -5 . T� <br /> M r •. 4P �c • <br /> ENVIRONMENTAL HEALTHDIVISION FILES <br /> 00 NDERGROUND TANK(UST)CLEANUp SITE(LOP) C3 HOUSiNG ABATEMENT 0 SOLID WASTE FAC1L.iTY <br /> OTHER CLEANUP SITE(NON-LOP) q ❑ FOOD FACIL" ❑ SOM WASTE VI:HiGLE <br /> UNDERGROUHR TANK(MONITORIMCM12MOVAL) CJ 006 KENNEL ❑ RAIRY 1: <br /> HAzARuous WAST@ GENERATOR 0 CHICKEN RANCH C1 PKCG TRfiA713 9W PLANT <br /> ❑ TIERED PEMiTTED FAMUTY 0 MUTEIMOTEL 0 PUNIPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOWBODY PEIRCING M :POQLJSFX ❑ LAND Olt APPLICATION WES <br /> CI MEDICAL WASTE FACILITY ❑ PUBLIC WATIM SYSTEM in OTHER cPL AsE sPECIFY ABOVE) <br /> 1. List up to ten addriasses In the space above. Select the type(s)of files from the list above by.chack)ng <br /> the appropriate bokes]. At least one file type MUST be selected. Fiax o 9 4 o the <br /> adclregs 10SUciltesl A <br /> 2. EHD will notify the applicant If any EHD flies exist. An appointment for revi�;i,r will be confirmecl <br /> approximately five business days but no later than tart(10)days after receipt of application.-The tiles <br /> will beheld for a maximum of five business days for review. Appointments sllauld be scheduled <br /> accolilirtgly. <br /> 3. A file'that Is active ly'baing worked on by EHQ staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any Lille not returned in;they same canditlon as released will be reorganized tay EHL)staff at the expense <br /> of the applicant. Futuna file reviews by the same applicant may require a $67:00 depositprior to review. <br /> a. 'TENTATIVE appointment data's must be confirmed with END staff. <br /> & Appllcabons received after 3:40 pin will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> GATE CONFIRMED PHONE FAX JNI•TiALS <br /> REVIEWED YES NQ REVIEW DATE <br /> Of4a 1.9 c /au <br /> TOWL P,01 <br /> S <br />