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�. ._.. .-�i.-�� ♦.i..ciru-i rrt��ri ..-. .._ .. .. Ili <br /> y � Clip Ull,nu NUln ' <br /> UAt¢RLCEIVLU ,[ �� <br /> SAN JOAQW COUNTYPUBLIC HEALTH SEfr..10ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> el .II :Ji-au I' <br /> 304 EAST WEBER AVENUE,THIRD FLOOR /, 7 <br /> STOCKTON CA 95202 ,;,, Co.; `�U <br /> (209) 468-3420 FlP 1� 09000PUBLIC RECORDS RELEASE APPLICATION Pt Fs <br /> �I�o'IhJl iEP '/,:. HEALTH <br /> APPLICANT �" �,/"y BUSINESS/AGENCYQr h'�I�� ��Qt�/1��✓�C ' Cl <br /> � <br />�- ADDRESS , � C. I "l CiCA C15�b`� <br /> PHONE�-1J-1 — q � �3 C 5� FACSIMILcE.� <br /> TENTATIVE'APPOINTMENT DATE <br /> '" g� �OO TIME <br /> (Please pivo 7 to 10 busiooss days from date of application submittal) <br /> CHECK BOX TO EXPEDITE RE BEST $78.00 FEE—RrOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE O Ili <br /> a <br /> U <br /> - FILE SS's <br /> Z �� � D <br /> )y (o W_ e•I2vu"-1_ ';t TrcL _- ...,..mss. � ' .�- f <br /> in <br /> N r L ' Avg 3 X95-3 n� <br /> cp L7. t iiFr s <br /> to -- <br /> ,1 2:2 Lc) <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ts�} UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> 1R. OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE �+ <br /> l� UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY <br /> 3K HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ZA <br /> 13 TIERED PERMITTED FACILITY 13MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS'.` <br /> O TATTOOIBODY PLACING d POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 tiles <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. 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 $78.00 deposit prior to review. 4 <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 /> L <br /> ED APPOINTMENT DATE TIME <br /> IRMED PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> EM 40 1. O1ro 00 <br /> R'Oock-n-) _ TOTAL P.02 <br />