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• <br /> FR <br /> TO <br /> P. <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICFS <br /> ENVIRONMENTAL HEALTH 01VISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOK <br /> j- STOCKTON CA 95202 LA <br /> (209)458-342C <br /> -� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �.APPLjCANT--LJ)1 ;q- j I/P1 U Li dc'�'- <br /> 1— OUSINESSIAGENCY <br /> ESS <br /> o Pti NE--,Lr)e <br /> TENTA-I-IVE'APPOI&TMENT DAT[ L11 01 $4-1 <br /> (F'103Se 91vc 7 Lo 10 bu-$inv6s Caya rrusti date orapplicalioA wwmtlal, <br /> CHECK 15OX70 LXRELATE RFQJESJII�,10 <br /> LEE J- UEIT PROCESSED fl '5111ESS DAYS <br /> �-SIGNATURE OF APPLICANT <br /> DATE. —t 1 o <br /> FILE ADORLSS THS SIDE EHO STAFF USE ONLY <br /> PROGRIVNI ELEMENTS SEARCH <br /> ---------------7-, <br /> 7 <br /> ENVIROKMENTAi-l-iEALTH DIVI310N FILES <br /> UNDERGROUKI)TANK(UST)CLEANUP 51TE 0 HOUSING ADAIIEMENT 0 SOUL)WYA51E FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) " FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TAKK(MONITORINGIREIADVAL) 0 DOU KENNEL 0 DAIRY <br /> ('C <br /> HA7ARDOUS WASTE G-GENERATOR G CHICKEN RANCH 1-1 PKTREATMENT PLANT Z3 TIF R12=0 PERMITTED FACIL ITY 0 NOTEUKOTLL Cl PVMPER TRUCKfYARDICHEM TOILETS <br /> 0 TATTOOIUODY PEIRCING 0 P00USPA - LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACJLI)Y 0 PIJULIC INATFR SYSTEM OTHER(PLEASE SPECIFY AGOVE) <br /> 1. List up to ter)addresses ill the space 400ye. ,Select the tYPO(S)Of files from the list above by checking <br /> the appropriate box(c5). At least one file type MUST be selected. FaX to(209)464-01.58 or mail to the <br /> a0dress_indicated <br /> 2. EMD will notify the?131711fcant if any EHO files ox;st. An appotntm.ant for review will be confirmed <br /> approximately live business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maXiMUal o1'five business days tor review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that i3 actively beim worked an by CHID staff may not be immediately available for review. A new <br /> application may be'Subrnitted when the file is available.. <br /> 4. Any file not returned in the SaMe condition as released will be reorganized by EHO staff at the expense <br /> afthe applicant- Fut'ure Elio reviews by the same applicant may require a$87,00 deposit prior to review. <br /> 5. *TENTATIVE appol! <br /> 61meat dates must be confirmed with EMD staff. <br /> 6. Appiicabons received after 3:09 Prn Will be prpcessad the next business day. <br /> CONFIRMED APFUNTMENT PATE TIME <br /> DATE CONFIRMED <br /> PPHONL- FAX (NITIAL,S <br /> REVIEWED YES NO <br /> Dols �cro7ao-- REVIEW DATE <br /> TOTnL. P.01 <br />