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FRO I �-{� $, >� mental FAX NO. : 2095690295 ec. 29 2005 05:48PN P2 <br /> � uglt',ZL�hJLi� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERViCE5 \ EHD NUMB[H <br /> ` 9 2005 ENVIRONMENTAL HEALTH DIVISION <br /> w <br /> -?-lr�l -- t_�. 304 EAST WEBER AVENUE,THiRD FLOOR <br /> E�d'vi-M,•if-JV[ 1i-F ,LTi-i STOCKTON CA 95202 <br /> F14,1','T,'SEjRV1G1`; (209)468-3420 <br /> /PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT /f e BUSINESS/AGENCY 45ce"',lw�-rP ;Fy <br /> ADDRESS r.L y � C>r f .a,,ciy /� <br /> PHONE ' , /y 2 p_ .^. FACSIMILEAir <br /> oft <br /> TENTATIVE".APPOINTMENT DATE TIME i ' <br /> (Pleaso give 7 to 10 business days from date of appilcation submittal) R <br /> ee{ <br /> CHECK BOX TO EXPEDITE REQUEST•$69.00 FEE-REQUEST PROCESS E N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATi; <br /> i <br /> FiLE ADDRESS THIS SiDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> d -.� .7 <br /> rc tr et <br /> 3 <br /> 1 <br /> ENViR M N ' HEALTH DMSION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> TtiER CLEANUP SITE:(NON-LOP) 0 FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELiHOTEL ❑ PUMPER TRUCK/YARDICHE•M TOILETS <br /> e TATTOO/BODY PEiRCING ❑ POOLISPA 0 LAND USE APPLICATION Sr ES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the spaco above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file typo MUST be selected. Pax 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 4%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 p:or 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 INIi IALS <br /> REVIEWED YES NO REVIEW DATE <br />