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�. i_, ._��� �•cirri rnui i ... ,,_ - _ <br /> i <br /> C140 LOG NINK" <br /> UATk CPCELVEU U <br /> SAN JOAQUIN COUNTYPBLIC HEALTH SECES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR,, I- e ;�t,�!'►LI Ii � � <br /> STOCKTON CA 95202 vfr:tk �y� {�'� ! �•� <br /> W <br /> a (209) 468-3420 ? 11 <br /> APR 3� Q � <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> LLpAy3 , <br /> APPLICANT <br /> ` T'"� BUSINESSIAGENCY <br /> ADDRESS <br /> i3 5' O oOl` <br /> PHONE <br /> PL <br /> �' FACSIMILE rn�v�''.R,F <br /> Wq/9� OO TIME !� <br /> TENTATIVE* APPOINTMLNT DATE k <br /> (Please oiva 7 to 10 business days from date of application sul <br /> I� <br /> CHECK BOX TO EXPEDITE REQUIEST�,7$78.00 FEE—R EST PROCESSED IN 3 BUSINESS-DAYS !r: <br /> SIGNATURE OF APPLICANT DATE ! d <br /> �r <br /> k <br /> FILE D SS' <br /> ;I <br /> Zz) <br /> . � <br /> i ENVIRONMENTAL HEALTH djV[SION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT >r50UD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON!-LOP) ❑ FOOD FACILITY a ❑ SOLID WASTE VEHICLE <br /> Ie( UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY JI <br /> TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR <br /> 13 CHICKEN RANCH 12 Ill <br /> Q TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCif1YARDICHEM TOILETS S <br /> C! TO ❑ LAND USE APPLICATION SITES <br /> ATTO/BODY PEIRCiNG R POOLISPA OTHER PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY ❑ PUE3LIC WATER SYSTEM <br /> (PLEASE <br /> �. <br /> List up to tan 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 tYl�" F <br /> addre§s 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 hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. it I <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. I� <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense . <br /> of the applicant. f=uture file roviews by the same applicant may require a $7$.00 deposit prior to review. I <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 PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 'ZSt?� TOTAL P.02 i <br /> c �I <br />