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TO 8581@90 P.01 <br /> ;b SAN JOAI2UIN COUNTYPUBLIG HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION r7� <br /> 3q4 EAST WEBER AVENUE,THIRD FLOOR / <br /> STOCKTON CA 93202 <br /> (209) 4MU20 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> v1PPLtCANr <br /> A70RESS� � _1 �_ G . �l l�cfi2.Vi�YA� ��19� tJ gEP_l9A . <br /> ,a.�t� , t►ao�, GP. `�24og <br /> FAC9tMILE�� 3A-\ •"' '�� <br /> TENTATIVE':1PPOINTNIENT 04TE. TIME <br /> (Plea"puleL7�t 1110/b/uain"&,;oya Ir dataa or�J11cauon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-597.0p�FEfi-R@ VEST PRESSPP IN 1 BUSINESS qpY$ , <br /> -SIGNATURE OF APPLICANT �(�(�� ` DATE 1 1 X71 oo� <br /> FILL ADYNis StoE EH-13-STAFF USEO�NLY <br /> PROGRAM ELEMENT,SCARCK <br /> . 53 jS-z 4 'SD <br /> uAu oQwk-1 -c to ay.Go <br /> 2\ �.. Zv�A \-.Au t}r�eTs\L t_•wk-C .Z9. <br /> 1� t��tit SI c Cb A© <br /> A >o r <br /> 2. tVCit�C V\ 357 d <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK CU"CLEANUP SITE(LOP) ❑ HOUSINO ABATEMENT <br /> OTHER CLEANUP SITE tNON.-Lop) p ❑ 50LID WASTE FACILITY <br /> FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MVNUORINOfRFMbvAL) L7 0013 KENNEL ❑ DAIRY <br /> Q }IAZAROOUS WASTE GENERATOR Q CHICKEN RANCH ❑ <br /> ❑ TIERED'PERMITTED fiAC1L1Ty t7 M UCKEN AN PKG TR£P.TMENT pL.A#T <br /> 0 TATTOOlaGuy PF IRCIN6 D PUMPER TRUCWYAROlCHSM TOILI?TS <br /> C MEDICAL WASTE FACILITY - ❑ POOL43PA ❑ LAND USO AppLICAT(ON SITES <br /> ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ITE$ <br /> +• List up to ten addresses in the space above. SQ E3 <br /> tbo type(e)of files from the list above by eheciing <br /> the apW opriate box(es). At least ane file type MUST be selected. F <br /> a¢orass inrlic�retl above �]L�4(2Q91 464-013E ar mail to I he <br /> 2• EHO will notify the applicanS if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bUS'ness;days but no later than tan (10)days after receipt of appl[cation. The files <br /> accordingly. <br /> held for a maximum of five busineSS days for review. Appointments should be Scheduled <br /> accordingly. <br /> file <br /> 3. a pli that is Actively being Worked on by EHD staff may not be iMMediatety available for revtew. A new <br /> xppItcabgfl may be submitted When the file is avanable. <br /> a. Any file not returned in the same condition as released will he reorgaTiizcd by EHD <br /> of the applicant. Future file reviews by the same applicant may staff at the expense <br /> require a $97.00 deposit prior to review. <br /> 5 'TENTATIVE appointment dates must be conFirmed With EHD staff. <br /> s• ApplicatlOns received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> I TIME <br /> DATE CONFIRMED <br /> PHONE PAX INITIALS <br /> REVtEWEI) YES NO '�— <br /> ++ a wo REVIEW DATE <br /> TOTAL P.01 <br />