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d3-30-ZW'1 ilk--sZfNq F <br /> G�l�N(Iccireu Foto LSNi�Mu+� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SE VICES <br /> ENVIRONMENTAL HEALTH DMSION � L4 �� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (MS)46$3420 <br /> rn pI PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT t , itC�L+�C� �r1 BU6lNESSIAGENGY /7 / /Y-rrociA.Lltr, Z G. <br /> ADDRESS -J�r.. �y <br /> PHONE q Z1 E`4 C0 0 ' J;300 - FACSMLE "T ' 41 D 3 - � <br /> TENTATNE"APP91NTMZNT DATE / MME Gr�L er�duy <br /> (Please gva 7to 0 bux�inaas days from data of aPPNr tion submittal) <br /> CHECK 80X 10 WYEDITE REQUEST-Sb7 -`E—,RE/4U PROC"$ED IN 7 BUSINESS OAY5 <br /> SIGNATURE OF APPLICANET DATE <br /> FITS ADDRESS THIS SIDE EIiD STAFF USE ONLY <br /> PRPGRAM ELEMENTS SEARCH <br /> yfIJLO [w>� fL�cc/L�a tf -- <br /> [ Od7 iPle od / L�oc k}Soy <br /> S3 nu <br /> 71'r—," e. <br /> J a/ aA/bon nau! J,Eoc 'boa .3•S' �-(• �T..J <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)Ct.F.AMLP SITE(Lop) Q HOUSINGABATEMENT =rSOLID WASTE FACtLI Y <br /> M(OTHER CLEANUP SITE(NON4,OP) ❑ FOOD FACILITY O 90M WASTE VEHICLE <br /> VNDERGROUNO TANK(MONITORING/REMOVAL) C3DOG KENNEL. 0 DAMP <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> Ci Til;RED PPRb rrED FACU.rTY 0 Mca'ELMOTEL A PUMPER TRUCWYARINQfEM TOILHTS <br /> ❑ TA7T0W600YPORCING D PMLJ ❑ LAND USE APPLICATIONSrtES <br /> O MEDICAL WASTE FACILrrY .Q PUBLCWATERSYSTEM Q OTIIER(PLEASE SPECIFY AUOVq <br /> 2. List up to ten address" in the space above. Select the bT*(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-U1,$S or mall to the <br /> gdd est indicated ab-me, <br /> 2. EHD will,notify the applicant if any EHD files qq is 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 fife that is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> appllcation may be submitted when the file Is aitallablo. <br /> 4. Any file riot returned in the same condition as re;le'ased will be reorganized by EHD staff at the expense <br /> of the applicant Future file reviews by the zari"pp(icant may require a$87.00 deposit prior to review. <br /> 5. •TENTATIVE appointment data;must be canfinrf�d with EHD staff, <br /> 6. Applications reCcived after 3:00 pm will be pros 4sad the next business day. <br /> CONFIRMED APPOINTmENT DATE TINE <br /> DATE CONFIRMED PIitlNE FAX 1NMLS <br /> REVIEWED YES NO '`+J.REVIEW DA'Z'E <br /> mi w +a axarroo • i <br /> TDTFL P.Q1 <br />