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WF <br /> 10 - <br /> wN:Gi'I Geo-Phase Lr'.�ir>=r�mcr�t.a1 i A:K NO. t095c.y4J2y5 1 I <br /> Aj SAN JOA(. ,,.N COUNTYPUBLIC HEALTH SERVI_.ji:�S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> n� DSC 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> Pte✓ Do-a c (209)468-3420 <br /> W1 I5 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 5'T'L'Cl�° i`G"f't���'� BUSINES&AGENCY_ I!SfO ��S4? J 'mac P, <br /> ADDRE$$ 3 7 Ale <br /> PHONE � �' a T <br /> FACSIMILE_'6K ; �� • <br /> TENTATIVE`APPOINTMENTDATE l d- ;VA92 <br /> - TIME lid <br /> (Please givo 7 to i D business days front date of ap llcatlon ubmitta <br /> �W1 Ts <br /> l) <br /> . , <br /> P[�Q_4ECK BOX TO EXPEDITE REQUEST-57a_00 FEE-REQUEST PROCESSI=DIN U- M S DAYS <br /> SIGNATURE OF APPLICAt DATE <br /> FILE ADDRESS <br /> L7�./.._. Ili <br /> �__._... <br /> -01 <br /> 1 <br /> 3 <br /> i <br /> 1 <br /> nn� <br /> ENVIRONMENTAL HEALTH DIVISION F1LF-S <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> �THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY CI SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) Q DOG KENNEL Q DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEUMOTEL 0 PUMPER TRUCKtYARoir-HEM TOILETS <br /> C! TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ hiEDICAL WASTE FACILITY 0 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 /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for roview 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 /> [CONFIRMEDAPPOINTMENT DATE TIME <br /> QATF-GONFiRMEQ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Eoa 14 01/0sl134D <br />