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SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES EHD 4QgNUMBER <br /> 8ENVIRONMENTAL HEALTH DI ` -IOW <br /> 304 EAST WEBER AVENUE,THIRD OOR..., <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ?CENED <br /> APPLICANT Cf 41.r Z_wz� (IUSINESSIAGENCY (�Z5✓5E7Cf <br /> ADDRESS <br /> .PHONE S-2 7-/..`/-7 LTH <br /> FACSIMILE pFRMIT/S fIRVICES <br /> TENTATIVE*APPOINTMENT DATE TIME - s <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-X89.00 FEE—REQUEST P E IN 3 BUSINESS BAYS 1 <br /> SIGNATURE OF APPLICAN !0 DA <br /> - �1 -- <br /> I� F - <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY I <br /> PROGRAM ELEMENTS SEARCH <br /> Al EL L /�s -tea <br /> o z �` C <br /> 19 <br /> it <br /> I, <br /> j ENVIRONMENTAL HEALTH DIVISION FILES <br /> -UNDERGROUND TANK(UST)CLEANUP SETS(LOP} ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> `OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> __C�-l7NDERGROUND TANK(MONITORINGIREMOVAL) © DOG KENNEL 171 DAIRY <br /> -O`FAZARDOUS WASTE GENERATOR ! ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY CI MOTEL/HOTEL Q PUMPER TRUCKIYARDICHEM <br /> TOILETS <br /> ❑ TATTOOIBODY PEIRCING CI POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 3 ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses iin 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 209 464-01.38 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 f <br /> will be held for a maximum of five business stays for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively befog 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 /> REVIEWEDYES NO <br /> _ REVIEW DATE .. <br />