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11-10 2-200 04:34PTI F11.) TO � iJ16861043e P.01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL-HEALTH DIVISION <br /> 304 EAST WE13ERAVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 I <br /> (209)468'-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLJCANT � r u BUSJHEMAGENCY �y <br /> ADDRESS rr �., � <br /> PHox PACSJ1111LE �LO � c�W - <br /> TENTATIVE`APP41NTMF_NT DATE 1 �e�E Q (2a.YY-) <br /> (Pleaie glve 7 to 116 business;days from date of application submittal) <br /> ED CHECK BOX TO EXPEDITE REQUEST-Slt7.66 FEE-REQUEST PROCESSED IN 5 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN _ _ DATE <br /> FILE ADDRESS THIS SIDE FIV STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> —_357,-2,:9 <br /> 11=55—.,) (I _ <br /> a3.5:a-7 rnu <br /> tr 3S a ren t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK IUST7 CLEANUP SITE(LOP) i3 HOU31NO ABATEMENT 0 SOL.io wASTe FAciirrY <br /> ❑ OTHER CLEANUP SITS(NON-LOP) EI FOOD FACILITY 0 SOLID WASTE VEHICLE 1 <br /> 0 UNDERGROUND TANK(111ONITORINGIRFMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GEkERATOR _ Q CHICKEN RANCH O PKG TREATMENT PLANY <br /> 0 T1ERM PERM11I ED FACILITY ❑ MOTELtHOTEL 13 PUIVER TRUCKIYeL[DFGHJ M TOILETS <br /> 0 TATTOOIBODYPORMNG ❑ POOLISPA Q LAND USE APPLICATION STM <br /> ❑ MEDICAL WASTE FACILITY ❑ FUSUC WATER SYSTE#kl ❑ 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 feast one file type MUST be selected. Eax 202 4=0738 ormail to the <br /> acjjre,ss1L)Jigated above. <br /> 2. EHD will notify the applicant it any EHO files exist. An appointment for review will be con€bred <br /> approximately five business clays but no later than ten(10)clays atter receipt of applica;ion.The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3_ R 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. Fut ire file reviews by the same applicant may require a$87.90 deposit prior to review. <br /> 5. 'TENT'ATIVE appointment dates:rust be confirmed with E,HO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> r <br /> CONFIRMED APPOINTMENT DATE TIME <br /> RATE CONFIRMED PHONE FAX INITIALS <br /> Rr_VIFWPn <br />