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1 =2BFUA) I F/EMC;(.V :Lis _za 3311 tt <br /> _6-18-2000 09!169M FROM To +---'1916928�41 P.02 <br /> ACLIVLU IND LUG NUYUtIC <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY <br /> ADDRESS 133 pia t�Y X' )ulE> Ck R-!2,)`� <br /> PHONE l LY "-�f7'-O ��ACJ 1\ l FACSINIlLE l r <br /> TENTATIVE*APPOINTMENT DATE V TIME C 0 PsYY1 <br /> (Plaase give 7 to 10,bilsincssdwy5 from data of application submittal) T <br /> u CHECK BOX TO EXPEDITE REQUEST.V 00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS U <br /> SIGNATURE OF APPLICANT y i>��r� &(2a__teZ DATE ( c]o <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTSSEARC14 \ <br /> l <br /> v <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK LUST)CLEANUP SUE(LOP) M HOUSING ABATEMENT ❑ SOLID HASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) f] FOOD FAc%L rry a SOLID WASTE VEHICLE <br /> UNDERGROUNZ)TANK(MONFTORWGIREhlOVAL) ❑ 000 KENNEL 0 DAIRY <br /> t{AZAROOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED EjMrrrEaFACILITY , fl MOTSLJHOTEL O PUMPER T-RUCYJYARDICHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING ❑ POOLISPA O LAND USE APPLICATION stiE.s <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Cl 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. Fax to(2091464-0738 or mail to the <br /> address)ndioated above_ <br /> 2 EHD will notify the applicant if any JEHD 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. Arty 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 578.00 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 PRONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 6F09 14 UA%M <br /> TOTAL P.02 <br />