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4� <br /> U.1T R G IV' V E iil)L(x;N1 RAM <br /> SAN JOAQUIN COUNTYPUDLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION - <br /> j �� 304 EAST WEBER AVENUE,THIRD FLOOR �O I <br /> �� STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ y �«-Q- a mOO(e�� BUSINESS/AGENCY <br /> ADDRESS <br /> or <br /> PHONE � _)���`C�3-17 FACSIMILE �O��Z�� <br /> TENTATIVE"APPOINTMENT DATE D S�O`Z Tmir: a "^ <br /> lease give 7 to 10 business ddYs from f�date oapplication submlttal) <br /> 17 CHZK 60X TO EXPEDITE-REQUEST-$(7788..00 FEE--RRE�EQUESSTROCESSED IN 3 BUSINESS DAYS 1 <br /> SIGNATURE OF APPLICANT ; � - DATE <br /> FILE ADDRESS <br /> S a \c4 pte.I�N '(ZD �tzeoac� Ca a.9�°_- <br /> \t�O�p�No�r - <br /> -- <br /> ,�t_�op�j P�ZRs�_t�1nn Go rnP�y _ — <br /> h <br /> 1 <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> nNDERGROUND <br /> TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT El SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> S7 UNDERGROUND TANK(MONITORI NGIREM OVAL) Q DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHram TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ ppOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILJ,1( M PUBLIC WATER SYSTEM +❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the typo(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. F 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 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 $76.00 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 /> EN 00 14 0VG_'VD0 <br />