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SAN JOAC N COUNTYPUBLIC HEALTH SEI-' =5 <br /> EN .ONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 0 /* (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT GASEE BUSINESSIAGENCY <br /> \ � <br /> 1 L <br /> ADDRESS 1117 PAL-M AU + utrk 3 AA,0 ASc15351 <br /> PHONE Zi " 2'S f}TL 1�I13T1 r�'/.T ��:-"4 I 2OlOr2 <br /> `7q r9/ 579 ' <br /> FACSIMILU TENTATIVE' APPOINTMENT DATE TIME (-NVIRC)NMENT HEALTH <br /> (Plcar,c give 7 to 10 busu,c��sa��days rro� plc I�icaf, ,ubDAY <br /> n1M.11) PERMIT/SER�fICES <br /> CHECK BOX TO. XPEDITE REQUEST-$07.00 FE�CQUL-ST PROC SSC US <br /> SIGNATURE OF APPLICANT DATE 40 ,/v <br /> FILL"ADDRESS THIS SIDE CHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �Ju7 L. D <br /> — 11 "--1 <br /> —*Z00 to .G — S Te C.K-7'o KJ �J <br /> So poa L O <br /> �1 <br /> ELL-4-or !mss►o - 941LU - <br /> O <br /> J 16020A <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY P14IRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTL FACILITY ❑ PUDLIC 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 checking <br /> the appropriate box(es). At least one file type MUST be Selected. Fax 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 worked on by EHD staff may not be irnmediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the samc 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 $37.00 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 /> w <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Lh 30 14 00107/00 , —'"-- <br /> ro <br />