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SAN JOAQk! 'IN COUNTYPUBLIC HEALTH SER"`CLS <br /> EN�ONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 209 460-3420 +� <br /> 01* ( � <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> GUSINESSIAGENCY T L 5Sou L <br /> 4PPLICANT G! SG-� IIaF A _ <br /> aODREsS ~1117 1.[�A1Lz f 1-►v► rtl1E Ltt r N J AOD t <br /> PHONE zb� �ZZLt FAGSIMILU ��l S79 ' 5 U 4 2002 <br /> TIME ' � iALTN <br /> TENTATIVE APPOINTMENT DATgive Y J llicalio ubmilla I) PERMIT/SERVICES <br /> (Please give 7 la 10 busine��ss��da Iroi ale 1 <br /> ❑ ' [iOx 70 LXPEDITE REQUEST <br /> .$117.00 FE�CQUL"ST PROC-SSE ?BU 5S DAYS <br /> CHECK <br /> DAT[ �- <br /> SIGNATURE OF APPLICANT <br /> FILL"ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> r c ° <br /> ptmL — s7b[.1L7"o�J <br /> �u.lor F�sr�6.rr� — 951• u� ° <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT C3 SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE{LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL O DAIRY <br /> UNDERGROUND TANK(MONITOKINGIREMOVAL) ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ IAOTEUHOTEL ❑ PUMPER TRUCKlYARDICHE-M TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOUSPA " ' ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY P14IRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WAsTL FACILITY <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(cs). At (cast one file type MUST be selected. Fax to 209 464-01311 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 /> approxii-nately five business days but no later than ten (10) days after receipt of application.-The files <br /> will be held for a maxilnum 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 EHO staff at the expenze <br /> of the applicant. Futurc file reviews by the same applicant may require a $137.00 deposit prior to review. <br /> 5. "TENTATIVE appointment date's must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> N <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED I YES NO REVIEW DATE <br /> tk ao 1 06107100 , <br /> w <br />