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• �0� / y <br /> + \ SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR / lJ <br /> 0� S 202 <br /> ((209)468 420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �iZ'C�' —'- \1V\002T2 BUSINESS/AGENCY Moe,.') <br /> ADDRESS �51� N42Xki Q "C <br /> \Vrc'r'SIO�C r�� \K\AL � GA �2�—(7 <br /> PHONE����2'"fai—�3�'7 FACSIMILE i NO <br /> 1ZT <br /> 2 --�,c� . <br /> TENTATIVE"APPOINTMENT DATE <br /> —t `�S❑�Z TIME <br /> .Sp /� �,dPlease give 7 to 10 business dos from date or eppecatfon submittal) <br /> CH&K 80 TO EXPEDITE—REQUEST-$78.430 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS - <br /> SIGNATURE OF APPLICANT ��YY�mr ' DATE <br /> " FILE ADDRESS - - <br /> ------------ <br /> opA �'E.T�_ mPaN - <br /> 3 aVY OQwz gt T�� �9GoIk <br /> LA -ttior� > a✓ L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 19 NDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> : <br /> Eg THEIR CLEANUP SITE(NON-LOP) C3FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> / UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOJBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY In PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <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(es). At least one file type MUST be selected. Fa(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 wori(ed 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 $78.00 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 /> EM 00 14 01MWN <br />