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. C�. 001 �y <br /> 07/02/100'210:28 FAX ��T � � � ��00Wuuern <br /> �. of VILE <br /> UAn WCOW <br /> }SAN JOAQUiN COUNTYPU13LIC HEALTH SERVICES <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> 304 EAST WF13ER AVENUE,THIRD FLOOR A­ <br /> STOCKTON <br /> CA 95202 D <br /> (209)4W3420 <br /> PUBLIC RECORDS RELEASE APPLICATION. <br /> `�l �'t-t►� �dNeo.fM�,Jr�ilr C�,nttn.Tri,�rt �+�c. <br /> APPLICANT 9Q BE-AAD BUSINESS/AGENCY <br /> ADDRESS �lb'� 1.�1M �R��er SvlT� �� ��° e��✓ `q• <br /> PHONE lD11-� FACSIMILE <br /> TIME q:Do p . • :.• <br /> TENTATIVE*APPOINTMENT DATE JwY (8 <br /> ppilaa(' ubmittal) <br /> s <br /> . (Freese give�busl �d f d - <br /> t;ESSED 10 BU ESS DAYS ; <br /> CHECK 13OX TO EXPEDITE REQU T489,00 -REQ S <br /> ` DA-rE <br /> SIGNATURE OF APPLICANTONL <br /> SjuE�EMD <br /> F11 <br /> ILE ADDRESS ' <br /> TPROGRAM ELEMENT. ?3 'BIRCH <br /> i.)eST AIRMCA .lE �OtL f.,+ MT�In. 0193 <br /> LS a <br /> ST <br /> �zo6 <br /> Rr.11 LA^fr CA sr�r�a nlga <br /> CA n4rio� n144 , <br /> ENVIRONMENTAL HEALTH DIVISION FILES ; <br /> —/ O HOUSING ABATEMENT 0 SOLID WASTE FAILT[Y <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 SOLiD WASTE u1 LE <br /> ❑ Foot)FACILITY q DAIRY <br /> ❑ THER CLEANUP SITE(NON-LOP) 0 DOG KENNEL ❑ PKG TREATMENT ANT " <br /> C UNDERGROUND TANK(MONITORINGIREMOVAL) 0 CHICKEN RANCH p PUMPER TRUCK -00 TOILETS <br /> O dAZARDOUS WASTE GENERATOR ❑ MOTEUHOTFL ❑ LAND USE APPLI&iiaN SITES <br /> TiEREP PERMITTED FACILITY ❑ POOLISPA p OTHER(PLEASE Srf_CIFY AB9 <br /> E3TATTOOIDODY pFIRCING 0 PUBLIC WATER SYSTEM f.E. <br /> ❑ MEDICAL WAS'IE FACILITY <br /> checking <br /> ace above. Select the type(s) of files from the List fib'. 1 y <br /> List up to ten addresses In the <br /> space a MUST be selected. Pax to (2091 464-dye or mail to the <br /> _ the appropriate box(es). At least one file type ointment for review will 15i-"onfirmed <br /> address indicated above. •EHD fifes exist. An app 4xtion. The files <br /> 2. EHD will notify the applicant if any 10days after receipt of anti <br /> approximately five business days but in later than o e�vieW. Appointments should bb;schsduled <br /> will be held for a maximum of five business day availablfe for review. Anew <br /> accordingly not be irrin►ediately <br /> 3. <br /> A file that(S actively being worked on by EHD staff may <br /> application maybe submitted when the file is Tejo available. re vire a b89.0p deposit prior to review. <br /> Any.file not returned in the same condition a5 rel8� will <br /> mayeorygani�ed by EHD'strff at the experts <br /> 4. <br /> of the applicant. Future file reviews by the sem® p ;f. <br /> th 9HD staff. <br /> 5, *TENTATIVE.appointment dates must <br /> b�P ocassedrmed tthe.next business day. <br /> 6. Applications received after 3:00 pm <br /> TIME <br /> CONFIRMED APPOINTMENT HATE. 1NiT1AL� ;�---- <br /> PHONE FAX <br /> DATE CONFIRMED <br /> REVIEWED <br /> YES NO REVIEW DATE <br />