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_ -; W _ . . I - L. <br /> I � 10 �fl013 F79 � ?� dPl rR TO 14154 35661 P - 172 <br /> nu �a : ::uuarX <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ca* <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, TFIRO FLOOR O <br /> t. =ro <br /> STOCKTON CA 95262 <br /> Alp <br /> A' �,�- - - - ( 46&3420 _-- <br /> PUBLIC� / SCR�ECORDS_RELEASE. APPLICATION <br /> P�� A M` j,L��+SI ��r-.r /�� % S &151NEESSS/�A,G,,ENCY J l � G/�Jj)l/�rffm ImA] f <br /> PHONE .�? fCl � PACSIh11LE tl � AGO _ <br /> TENTATIVE" APPOINTMENT DATE ' f _ `-' TRIPE <br /> (Please give 7 to 70 hu:incss days from dale of appl;catien zvbmiltni) <br /> CHECK BOX TO EXPEDITE REQUESI A $ST. QFEE - RFOIASTT RCCEESS_E,D H BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �' 4 DATF, ID 17 <br /> FILE ADDRESS THIS SIDE EHD STAFFUS6 ONLY <br /> F PROGRAM HLEMrNT5 SEARCH - <br /> S. I ret to } <br /> " <br /> ENVIRONMENTAL HEALTH DIV13ION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) D HOUSING ABATEMENT D SOLID WASTE FACILnY ��� d <br /> / ❑ OTHER CLEANUP SITE (NON-LOP) u FOOD FACILITY SOLID WASTE VEHICLE , J <br /> ID UNDERGROUND TANK (MONITORINGIREMOVAL ) D DOG KENNEL 11 DAIRY <br /> D HAZARDOUS WASTE GENERATOR D CHICKEN RANCH D PKG TREATMENTPLANT <br /> Q TIERED PERNITTED FACILITY 6 MOTELIHOTEL D PUMPER TRUCK/YARD/CHEMTOILETS <br /> D TATTOOIBODY PEIRCING P POOLISPA O LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY ' 0 PUBLIC WATER 5YSTE A O OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ten addresses in the Space above. Select the lyoe (s) of files from the list above by checking <br /> 7 the appropriate box(es). At least one file type MUST be selected. Fax to 1209) 464-0138 or mail to the <br /> fp addrel¢ ind"caied 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 fur revicam. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worKed on by EHD staff may n<;t 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 bame 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 SB7.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EFIO staff. <br /> 6. Applications received after 3:00 pm will be processed the .ToXt business day. <br /> CONFIRMED APPOINTMENT GATE _ TLME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO _ REVIEW DATE <br /> IN W 4 W07NO <br /> I TOTAL P . E)2 <br />