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— — I-I-.UI'I U J3858b2 P.02 <br /> JA'I'L I<ECEIVL'Uj / <br /> SAN JOAQ_.A COUNTYPUBLlC HEALTH SERVtuES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 1 i/ <br /> PUBLIC RECORDS RELEASE APPLIC T - <br /> A tq��I�� <br /> 47VT 7, <br /> APPLICANT C, I\�.0 J BUSINESS/AGENCY �7 Q�j '=1'I: <br /> `� , h ` c <br /> ADDRESS amyl (Z . NJ�r �� \r`( 13Az C (� F?t / : " /LTH <br /> `� 3 `HT1 sER✓1� �--- <br /> PHONE a:DC1 - G 3__S y 3-14 FACSIMILE D-Oc� – S 3 - S5? v <br /> TENTATIVE*APPOINTMENT DATE f 1,4 U TIME � <br /> �j (Please give 7 to 10busine5sday6 from date of application submittal) ! <br /> CHECK BOX TO EXPEDITE REQUE T-,$78.00 FEE—R UEST PROCESSA�USiNES DAYS <br /> SIGNATURE OF APPLICANT1 <br /> 'Z�,� z� v— _ <br /> � DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> \ S r ';): �/ L <br /> ' <br /> O J n O\ G ) <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(MONITORING/REMOVAL) ❑ DOG KENNEL. ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING C) POOUSPA C7 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 13 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 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. EMD 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 immediately available for review. A new <br /> application may be submitted when the file is available. <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. Future file reviews by the same applicant may require a$78.00 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> fH 00 14 0=4100 <br /> TnTnn n-� <br />