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UAI L IILLLIVLU <br /> .• w SAN JOAQUIN COUNTYPUBLIC HEAL SERVICES "'os°°NUMeE <br /> • ENVIRONMENTAL HEALTH DIMION <br /> I 1 304 EAST WEBER AVENUE, THIRD FLOOR <br /> D STOCKTON CA 95202 <br /> (209)468.3420 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT -1 �� C6 QQ <br /> BUSINESSIAGENCY Sleoly. e'VD CAIUG-ECC_- <br /> ADDRESS ��� E 1,)ASN ,1167-0, 2 r PSD N{K h2 <br /> 567 Uro <br /> PHONE 02 <br /> X <br /> FACSIMILE_ &0 hoc) <br /> TENTATIVE"APPOINTMENT DATE <br /> (Please glue 7 to 70TIME <br /> da s from d e of Iical on ubmillal) <br /> CHECK BOX TO EXPEDITE REQUEST 09.00 FEE-R UEST�R E ED SINE DAYS <br /> SIGNATURE OF APPLICANT A44J— DATE <br /> FILE ADDRESS .THIS SIDE EHD STAFF USE ONLY <br /> -'] PROGRAM ELEMENTS SEARCH <br /> 1�0.3 � uCl< i2EE lC C+ 2 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 4UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ <br /> — UNDERGROUND TANK(MONITORINGIREMOVAL) 13113DOG KENNEL SOLID WASTE VEHICLE <br /> HAZARDOUS WASTE GENERATOR p DAIRY <br /> CHICKEN RANCH 13PKG TREATMENT PLANT <br /> ❑I'll TIERED PERMITTED FACILITY <br /> C3 TATTOO/BODY PEIRCING ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 POOL/SPA <br /> ❑ MEDICAL WASTE FACILITY11❑ PUBLIC WATER SYSTEM ❑ LAND USE APPLICATION SITES <br /> OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types) 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 reldased will be reorganized by EHD Staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> � <br />