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SAN JOAQUIN COUNTY <br /> EN% JNMENTAL HEALTH DEPARTM <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> JUL �} Zd�3 STOCKTON CA 95202 <br /> (209) 468-3420 464._ O f 3e5 <br /> PUBLIC RECORDS RELEASE APPLICATION 1003 <br /> APPLICANT . QN L 14iE:51V - Y BUSINESSIAGENCY <br /> ADDRESS R 4-OG <br /> PYPHONE 'O FACSIMILL Yea <br /> TENTATIVE' APPOINTMENT DATE TIME _ <br /> (Please carve 7 to 10 business days from date of application submittal) -3q <br /> 11 • <br /> CHECK BOX TO EXPEDITE REQUEST- �_O() <br /> FEE ST PROCESSED IN 3 BUSINESS DAYS r r <br /> SIGNATURE OF APPLICANT DATE �IIJG �� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> oRrconl CNuRcN - A7 a w! Ka oro/ !�/k rRAC <br /> GAi-V,Art8s vc E - lj9&ZI IV. (Z. A9 <br /> aR c o,�r. ung12171 L) P-- <br /> / Ivy Wr5L-LGOLtS_AND kc-EoG 53rem:' 4+auND - <br /> _I_30L0_50UTt4 CeUr- <br /> 27000 � ZgOao Gd/1/t,�L. f-FoGc.oaJ j <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1-` UNDERGROUND TANK (UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q. SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY R. SOLID WASTE VEHICLE r <br /> fi. UNDERGROUND TANK (MONITORING/REMOVAL) 0 DOG KENNEL 0 DAERY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH -O-PKG TREATMENT PLANT---� <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> D TATTOOIBODY PEIRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <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. 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 $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 /> 7)ATE CONFIRMED PHONE FAX INITIALS <br /> 'VIEWED YES NO REVIEW DATE <br /> ne—ai-ocs <br /> i�n� <br />