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SAN JOAQUIN +`:o rypuBLIG HEALTH SERVIcF-S <br /> offlamus 1VIRONMENTAL HEALTH DIVISIC. <br /> r 704 EAST WEBER AVENUE,THIRD FLOOR' <br /> STOCKTON CA 95202 <br /> z . (209)46a-3420 <br /> 011 <br /> mg PUBLIC RECORDS RELEASE APPLICATION <br /> �} <br /> APPLICANT Ae— BUSINESS1AGPNCY Ql)LI&AC f� Lf &OIL261dn �I} <br /> ,.� . <br /> AVDRESS '7 0.5— /U. OhoQ clLo09- -2y <br /> PHONE d'Q -` � FACSIMILE <br /> o <br /> TENTATIVE*APPOINTMENT DATE � TIME /f r�.�/ �ZZ � <br /> iPlease give 7 to 10 b sines;days from data of appilt"Con scbmlRal) Cn m po <br /> • rn� <br /> CHECK BOX TO EXPEDITE REQU T-;711.00 FEE-REQUE T RO ESNLP IN 3 BUSINESS DAYS � Z N <br /> O f <br /> SIGNATURE OF APPLICANT DATE �. nil, <br /> x <br /> n1 -�a } FlL .A RE5S <br /> D //&W M ' S <br /> J7 717 <br /> 30 <br /> 5 At' ne ZCr <br /> !gyp , lna t~i Les ... L%5-, Ly-, t-Lit- b 8 Ro-zh RW; "'s so 6.R07-P'10r <br /> ENVIRONMENTAL H ALTH DIVISION FILES <br /> UNDERGROUND TANK lU"CLEANUP SITE(Loi') 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) C] FOOD FACILffY ❑ SOLID WASTE VEHICLE. <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY } <br /> HAZARDOUS WASTE GENERATOR 0 CKICKEW RANCH 0 PKG TREATMENT'PLANT <br /> TIERED PERMITTED FACILITY U MOTEtJHoTEL 0 PUMPER TRUCKfYARMCHI=M TOILETS <br /> 0 TATTOWBODY PEIRCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 1pCgTHERl!PLFASE SPECIFY A90 _ 5y <br /> iLW. ?ITLC 5 <br /> �3na� <br /> 1, List up to ten addresses In the space above. Select the type(s)of files from the lis Bove by checking } <br /> the appropriate lox(es). At least one file type MUST be selected. Fax to (,20914164-D138 or mail to the l <br /> address indicated above. <br /> 2.- EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed j <br /> approximately five business days but no later than ten (40) 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 expanse <br /> of the applicant. Future file reviews by the same applicant may require a $76.00 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 DATI= TIME <br /> DATE CONFIRMED PHoKE FAX INITIALS - <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 A1MMO <br />