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� r coos io co rn cos V40VO41 - 191 UU1 / UU <br /> OATS RF' NEa ENO LOG NUMBER <br /> D SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �� 1 304 EAST WEBER AVENUE, THIRD FLOOR <br /> 2�Q4 STOCKTON CA 95202 <br /> MAR $ { (209) 4683420 <br /> �T k9LTN PUBLIC RECORDS RELEASE APPLICATION <br /> tT�SE put peq p�/ <br /> , � rrr r •� r 13USINES31AGENCY glerk f�fC!'err Siie, MI <br /> ADDRESS a aS M rile 4`?ee tS7f7c� cif <br /> PHONE 2i79 - 9yB' 13y17 FACSIMILE 9yB� 6# 060?/ <br /> TENTATIVE' APPOINTMENTDATE 3Oy TIME /04+i1 <br /> rr� }f (Please give 7 to 10 businessdays from date of application submittal) ; <br /> I CHECK ED TO EXPEDITE REQUEST • 7.00 FEE — REQ 3 r PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE 0. APPLICANT C _ fefrCr DATE SO <br /> ` FILE ADDRESS rpTHIS SIDE EHD STAFF USE ONLY ) <br /> PROGRAM ELEMENTS SEARCH <br /> gum <br /> �B v �1 ClJvl� oar �Q <br />' e <br /> i <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> a' UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> FT OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> 4 <br /> 12T UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL - ❑ DAIRY <br /> (7 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLAN <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL . ❑ PUMPERTRUCKlYARD/PrIMTOULTS . <br /> ❑ TATTGOIBODY, PEIRCING ❑ TOWSPA ❑ LAND USE APPLICATION SRES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 checkin4 <br /> the appropriate box(es). At least one file type MUST be selected. Fax 20 464.0136 or mall to the <br /> address indicated above. . <br /> 2. EHD Mil 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 bheld for a maximum of five business days for review. Appointments should he scheduled <br /> acco dingly. <br /> 3. A file] at is actively being worked on by EHD staff may not be immediately available for review, A ne' <br /> application may be submitted when the file is available. <br /> 4. Any file not retumed In the Same Condition as released will be reorganized by EHD staff at the expens <br /> of the applicant Future file reviews by the same applicant may require a $87.00 deposit prior to revlea <br /> 5. TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Appl atlons received after 3.00 pm will be processed the next business day. <br /> r <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED voc NQ REVIEW DATE <br />