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DATE RECEIVED <br /> ' SAN JOAQUIN COUNTYPUBLIC HEALTH-5ERVICES <br /> RENVIRONMENTAL HEALTH DIVIL })N <br /> . 304 EAST WEBER AVENUE,THIRD FLR. <br /> S70CKTON CA 95202 <br /> (208)4613.3420 - <br /> PUBLIC RECORDS RELEASE APPLICATION ENO <br /> APPLICANT L',�4# � PAXPG4l 6itAUSINESSIAGENCY .7 '""S'��M _1111N_1 9. 7W <br /> ADDRESS LTH <br /> PHONE S-2 7--:'/� 7 FACSIMILE PERMITISERVICES <br /> TENTATIVE*APPOINTMENT DATE x TIME ' <br /> (Please give 7 to 10 business days from date of application submittal) <br /> �At <br /> rs O.S. <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE REQUEST P ESSE IN 3 BUSINESS DAYS <br /> SIGNATURE OF.APPLICAN ' A E4ze <br /> ,, <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> i <br /> PROGRAM ELEMENTS SEARCH <br /> tai rr�r+�ri;,r! <br /> I <br /> a <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> F ,fn--UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> _12-OTHER CLEANUP SITE(NON-LOP) P FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> _Z3-UNDERGROUND TANK(MONITORINGIREMOVAL) b DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH a PKG TREATMENT PLANT <br /> A TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILE'T'S <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Ls Q PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 9. twist 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. i; <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 $89.00 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 /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ <br /> i1 <br />