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UMIL11IULIVLU <br /> SAN JOAQ& ` .COUNTYPUBLIC HEALTH SERES EHD LOG NUMUER <br /> EN��I ONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ^ PUBLIC RECORDS RELEASE APPLICATION ll 11 <br /> APPLICANT CAF=L Go,,)AQ BUSINESS/AGENCY GOWA�] <br /> ADDRESS Is, wc-_5t %t, St'Tr. C i OA(—V <br /> PHONE_Z097-4 B2- FACSIMILE aq✓C7•�o` li3 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of application submittal) <br /> r7 CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT CC4 L,-) qt`�3_� DATE I Z 30 99 <br /> FILE ADDRESS <br /> 2S 0 t c. <br /> Z '577 5, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL Cl PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 file type MUST be selected. Fax to (209) 464-0138 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 EHD 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 /> CONFIRMEDAPPIN <br /> OTMENtTDATE f T „I, Fi nary„�vp�c <br /> fity� y`;�i n1 rVAYl %""IIVb/r1�(1f�Ci„I 14 8y' y'� <br /> • , r 9 ;P' i« '9d <br /> DATE CONFIRMED. �'I .` a `PHONES FAXv L';.. INIT,IALS <br /> REVIEWED YES NO REVIEW DATE <br /> 8130199 <br />