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12!EJ7/20Ei1 11:42 '309';790348 OFFICEII4AX It 0627 PAGE 01 <br /> DATE REC ENED EHD LOC.NUMBER <br /> SAN .,JAQUIN COUNTYPIJBLIC HEALTH .,�;RVIGES <br /> ENVIRONMENTAL HEALTH DIVISION 7 /� I <br /> J 304 EAST WEBER AVENUE,THIRD FLOOR lJ <br /> b STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASEAPPLICATION <br /> APPLICANT BUSINESSIAGENCY <br /> ADDRESS p�\ �STK K \Vrc�SCO� ir�7 E. tr\AL'C� r G A �J`�_ 77 <br /> PHONE FACSIMILE <br /> FACSIMILE �O",a��-T"�—� <br /> TENTATIVE*APPOINTMENT DATE 1 7-S�C�`Z TIME - <br /> (Please give 7 to 10 business days from date of application submittal) <br /> (div/7- 3 CHECK BOX TO EXPEDITE REQUEST-$79.00 FEE-REQUEST P//OCSSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,t� DATE <br /> FILE ADDRESS <br /> C.Qt�T1NEN'T� ��Al� C�tv�Pf�Y <br /> �r\zLRN 20 V V_ CAmlp - <br /> \t�on�o��c <br /> r oQs� P�TC2.��1.fYt C.omPAt�y n � O �✓ G <br /> �3 AVY oa\vim g-trY-,�-�oaU <br /> V BTU CST Oi!, S`I L-� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ((OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 3y UNDERGROUND TANK(MONITORI NGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 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 /> lddress 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 $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 /> EH 00 14 oih35lDO -- - <br />