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SAN J#QUIN COUNTYPUBLIC HEALTH SERVICES <br /> VIRONMENTAL HEALTH DIV <br /> 304 EAST WEBER AVENUE,THIRD FLOLOO <br /> STOCKTON CA 95202 <br /> RUS <br /> ' (209)4683420 <br /> PUB�IL�IC� RECORDS RELEASE APPLICATION <br /> APPLICANT .0 i1e. � KJ ay BUSINESSIAGENCY Qduunced [1PO�J7UyV'Di'1/Yl n !J� rI7�, <br /> ADDRESS VD S /�• t�VI�SO Q C fn CAZZ <br /> sa/oXsn <br /> PHONE aD Z FACSIMILE i �` " < <br /> • � C <br /> TENTATIVE'APPOINTMENT DATE TIME Zn <br /> (Please give l to 10 b slness days from dale of application submittal) <br /> m Z o <br /> y� CHECK BOX TO EXPEDITE REQU T-$78.00 FEE-REQUET RO ESSED IN 3 BUSINESS DAYS 2 p <br /> SIGNATURE OF APPLICANT DATE <br /> FILE A KESS <br /> c- <br /> / d <br /> i7i� S 1 <br /> £ 30 <br /> nt ,Ellne <br /> ?2510 <br /> pro , nd C-ides ..- �** WSO In hour b8 _ "Ro1KIgOOJ' fI'8S0 r-- P077, r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MOWTORING)REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 17 TIERED PERMITTED FACILITY ❑ MOTEL)HOTEL ❑ PUMPER TRUCKIYAROICHElk TOILETS <br /> ❑ TATTOOIBODY PEtRCING ❑ POOLISPA ❑ LAND USE APPLICATION SIT S <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 'pCOTHFRPLEASE SPECIFY A OVEL <br /> winks !� t <br /> 9f7C `�I o�Gt(�t3C, <br /> 1. List up to ten addresses In the space above. Select the types) of files from the list bove y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 4$,4-0138 or m ii to the <br /> address indicated above. <br /> 2. EHD will notify the applicant it any EHD files exist. An appointment for review will he confirnr ied <br /> approximately five business days but no later than ten (10) days after receipt of application. Theffies <br /> wilt 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 /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm wilt 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 09 14 olwur <br />