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SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> \p� 304 EAST WEBER AVENUE,THIRD FLOOR / <br /> V STOCKTON CA 95202 <br /> (209)468-3420 <br /> S ` PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �2'C.�'� YN(\00C_Z BUSINESSIAGENCY <br /> ADDRESS ���� NC]2SN \VfcQ-^—�lQ J E K-\AL'CQ ��C.f\ �_� -T7 _ <br /> PHONE FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE r�-i`?�Z TIME C rc> y <br /> /�,�F,/[Pleese give 7 to10UUl7-S s fr/o'm,'fd/ate or appecelfon suUmlttall <br /> ❑G�CH£GK BO TO EXPE 17f4 EQUEST-$770.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ���'� DATE <br /> -- FILE ADDRESS <br /> Se F1P.eiRa R.D F2elx�Cw a.9�e <br /> -- <br /> \14� Wiest C--kA Y, sccrlccol.�_ .35 9 29co <br /> - <br /> '?s��'3 q�1Y Oa>,y� r3tc�cu_zon5 29Go <br /> 'p t �TocK'CON <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> VP[NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 31/OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ld UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEI RCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACIL77Y ❑ 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. Fag to(209)484.0138 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 recoipt 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 MIA 01MWN <br />