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11-10-2C-00 04:34fT1 FF TO � 19168616430 'f".01 <br /> �.y�•••••• - eJw LUU N"b&' <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES I� j <br /> ENVIRONMENTAL HEALTH DIVISION j <br /> 304 EAST WEBER AVENUE,THIRD FLOORI j <br /> STOCKTON CA 95202 <br /> (208)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> g �C � :n �)c l ¢APPLICANT BUSINESS( GENCY tSt <br /> ADDRESS [� �� EgJ/� - II <br /> FACSIMILE i=J — W � <br /> PHON LO C �4��,��' -- <br /> TENTATIVE•APPOiNTMENTDATE_ O-YYl <br /> (Ple$ae glue 7 to days from date of applltatlon submittal) - <br /> CHECK BOX TO EXPEDITE REQU_ES�T-S07.00 FEE-REQUEST PROCESSED IN BUSINESS DAYS , <br /> SIGNATURE OFAPPItCANe-�2 � DATE (k 1 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH It <br /> GA omy) <br /> - <br /> o3S. <br /> a35.a 7 rkU <br /> Y 3 S•a �' r.n;. •z 'e <br /> -FA 61 <br /> o35a� <br /> I ENVIRONMENTAL HEALTH DIVISION FILES14 <br /> UNDERGROUND TANK[Us-r)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT t7 SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) - Cl FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(N,ONrrORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIEREDPERMul FACIUTY ❑ MOTELIHOTEL O PUMPER TRUCK/YARMCHENTOILETS <br /> 4 TATTODUBOOY PEIRCING ❑ P60 JSPA 0 LAND USE APPLICATION SITES <br /> 1 0 MEDICAL WASTE FACILITY ❑ PUBUC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> i 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(2091464-0138 or mall 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 /> I 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> 1 application may be submitted when the file is available. .1 <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at thetexpense <br /> i of the applicant Future file reviews by the same applicant may require a $87.00 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 /> I <br /> DATE CONFIRMED PHONE FAX INITIALS 4 <br /> i <br /> i <br /> ua II <br />