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- l�Op NUMBER <br /> . SAN-IOAQUIN COUNTYPUBLIC HEALT''--SERVICEq �,� END <br /> ;ENVIRONMENTAL HEALTH DIV6001N 1t11 t��� �1'�I E0 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 SEP. 3 0 ZOOZ <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIONENVIRONMENT HEALTH <br /> APPLICANT P,11 f fIIr D17. SUSMESSIAGJENCY <br /> ADDRESS 3 6� 2 f��ti.S��n'� 141 I kna r- CA <br /> PHONE ?z' GI 9 `3$ Z^] FACSIMILE <br /> TENTATIVE*.APPOINTMENT DATE - TIME �- <br /> (Please give 7 to 10 business da from a of ap Icatlon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 9. 0 FEE- REQUE PROCESS�D 1 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT J��M� 'yC� L`'L� ' DATE '30 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS StARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY t <br /> OTHER CLEANUP S1TE.(NON-LOP) © FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINQIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑' MOTEL/HOTEL Cl PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODYIPEIRCING CI POOLISPA 17 LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY R 0 ,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. Anew <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 />