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b / / Ll / LFT t74 13 : 7J LUy-D / y - I 04L5 MUUt51U (al (: <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEESER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> JUL 2 1 2004 ) 468-3420 <br /> PUBLIC RECORDS �RELEASE APPLICATION ' <br /> APPLICAO� l EN 6A[W /`Fk `�-"'\ BUSINFSSIAGENCY / Cr� <br /> AOURESS _ l(�}- (_a'�*A+- 001 un Qy-L 11# . Su �-c�t /AnoSsa ,(a <br /> PHONE 'Z `O`f � � - 7.2.E l FAC IMILC _ <br /> [ Zl )� <br /> TENTATIVE" APPOINTMENT DATE v 'bq TIME �yQ <br /> (Plc�. c Diva 7 to � D bu;inas: Uays (rain dale of opplicalion : ubmilty) <br /> © CHECK BOX TO�CXPEDITE REQUEST A $07.017 FEE r RCQUJES� TPROCESSEO IN 7 DUSINCS DAYS u I <br /> SIGNATURE OF APPLICANT �/�.�. y c �/(�/v � � DATE <br /> FILE ADDRESS THIS 51DE LHD STAFF USE ONLY <br /> PROGRAM CLEMENTS SEARCH <br /> W. AVA. k <br /> \ e . `Ia1�„tn , ►t Mvvt ea. q ' D h11: ? 5'7la 7 i, ) <br /> �'J C lit. W �o S Lk cY •\ 3 S (� 1"i1 L <br /> M <br /> `i `t9 A <br /> UI � Z tiCl � e K C. J <br /> tLt t Abvn a 5 } ocK <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 5IeUNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 4 OTHER CLEANUP SITE (NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ GHICKCN RANCH 4 PKG TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTEUHQTEL ❑ PUMPL'RTRUCKfYARDICHCM TOILETS <br /> ❑ TATTOOIBODY P91RCING ❑ POOUSPA Q LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTLS FACILITY 0 PUDLIC WATER SYSfiEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ten addresses in the space above. Select the typo (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) 464-0136 or mail to the <br /> address indirated above . <br /> 2. CHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bdsiness 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 bo immediately available for review. A new <br /> application may be submitted when the file is availablo. - <br /> 4 . Any file not returned in the same condition as released will be reorganized by EHD staff at the cxpen5e <br /> of the applicant. Future file reviews by the same applicant may require a $ 07.00 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 k YES NO REVIEW DATE <br /> kH 11 a Iron <br />