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ui/b7/2UO2 i6:bo 2054b711 Ak;.E SCU�;KIU, i Ly' U_ <br /> uia�c nc�rrtu � EH4 LpG HUhl6krt <br /> SAN JOUIN COUNTYPUBLIC HEALTH S> 10ES <br /> SENVIRONMENTAL HEALTH DIVISION <br /> J 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (208)468-3420 � <br /> # �? PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAN10� <br /> BUSINESSIAGENCY mp <br /> ADDRESS [f J� Q <br /> PHONE 47b) ( (� ! IaU/V F CSIMILE / _N <br /> TENTATIVE"APPOINTMENT DATE � , 1 i It TIME �LJ•,V�/ <br /> (Please givs 7 to 1 lfbusiniFss days from date of applfcatlon submittal) <br /> !:v1775 2, V <br /> CHECK BOX TO EXPEDITE REQU $78.00 FEE-R11 UST PRPCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> rS 1W C& <br /> u�?`d a <br /> tic 51 <br /> tr Ir3, 2-& 9 .ikl <br /> 3 <br /> Ir !► <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL © DAIRY <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY Q MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM•TOILETS <br /> ❑ TATT'OOIBODY PEIRCING 0 POOLISPA d LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY CI PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1 List up to ten addresses in the space above. Select the type(s) of files from the list above by checking j <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 2 9 404-0138 o the <br /> 'a r S indicat d abpv6 <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business[lays but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled , <br /> accordingly. <br /> Staff may not be immediately available for review. Anew <br /> 3. A file that i$actively being-worked on by EHD <br /> application may be submitted when the file is available. <br /> 4. Any file not returded in the same condition as released will be reorganized by EHDstaff at the expanse <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 /> EK 00 14 01105M <br />