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i c� io a <br /> F!ID LOC NVmuEH <br /> UAI C PECFI`/FU <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION S� <br /> 304 EAST WEB ERAVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 1, <br /> (209)468-3420 <br /> _ <br /> PUBLIC <br /> ' RECORDS RELEASE <br /> �APPLICATION <br /> APPLICANTS •. . (:(1_ /, J�il>',�._. 131.15INESSIAGENCY <br /> ADDRESS ���Nr, .r .\1� E-_�,�{a�J �_ya� Qc <br /> PHONE ( l� �t FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE <br /> (Please give 7 to 10 huslnesa days from data of aPPlicadon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$70.00 FEEw-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> c.:_ 7 �i.u�.,_q (�(�r,�„�._ DATE A- <br /> SlE3NdTURE OF APPLICANT J^_�- {T <br /> FILE ADDRESS , -• -r <br /> Vic, \ C-tAv`�Q—l..r�—�r`�'.7•�� .- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ffi UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD fACtLITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ -CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 11M <br /> MOTELIHOTFL ❑ PUMPER TRUCKAROICHEM TOILETS <br /> ❑ TATTOO/.a0DY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List up to ton addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax_t (2209 464-0138 or mail to thq <br /> addressindicated 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 ton (10)days atter receipt of application. The files <br /> will be hold 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 now <br /> application may be submitted when the file is available. <br /> 4- Any file not returned in the same condition as released Will he 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:OD 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 /> EH d0 A ay.voo <br />