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SAN JOAQUIN COUNTYPUBLIC HEALT)d SERVICES <br /> ENVIRONMENTAL HEALTH DI' ;JON <br /> 304 EAST WEBER AVENUE,THIRD�-C�(lOR <br /> STOCKTON CA 95202 <br /> (209)468.3420 JUL 11200 2 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r1 P �arS <br /> 13USINESSIAGENCY � v1G ��lnli✓1.i P S , <br /> ADDRESS 7 �'r <br /> PHdNEipC91 r�4 - 7JG <br /> FACSIMILE AO% 01 <br /> TENTATIVE*.APPOINTMENT DATE TIME <br /> (Pleasegl a to 1 b41neays f date of application submittal) <br /> Me •CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE- T PROCES D 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE �_ I "� <br /> . r <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH j <br /> � G h SfiLG 3 00-3a- r <br /> (� r-r.-p <br /> 3-6 t L kir <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ¢� UNDERGROUND TANK(MONITOR INGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY k <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITYM PUBLIC WATER SYSTEM C OTHER(PLEASE SPECIFY ABOVE) <br /> r <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above bylchec Ing <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to he <br /> address Indicated above. P <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 /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO' REVIEW DATE <br /> 0 0r.nnr <br />