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LA a t ebb I I e KLEINFELDER 1A. 002 <br /> J9 9480521 SACIiLr1.ff-TO Q1003 <br /> • dfp l04 MU►IDCR <br /> SAN J AQUIN COUNTYPUBLIC HEALTH SERVICE <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVI=NUE,THIRD FLOOR <br /> J.) STOCKTON GA 99202 <br /> (209)468-a20 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ,her i -,yta— PV- euslNES&AGiNCY <br /> 30-71 p4c, <br /> vl I Jar l'71 CP Y 37-0 FACSIMIL U(� 0)?kc-c0-_ 701-:5 c—--- l <br /> :✓vUl�4.���7 �2 C�Iir,J,tt.l C l <br /> TENTATIVE-APPOINTMENT DATE Y TIME <br /> (Ple"a give T to 10 bush«=days from date of appliotlon submlt"l) '-3# <br /> Q ' T FQE—REQUI' P20CESSED IN 3 BUSINESS DAYS ' <br /> CHECK IiOX TO EXPEDITb RE LJi�-Sa�OQ 8� ') <br /> SIGNATURE OF APPLICANT �� !I ,L /C/ DAT1; _ <br /> FILL=ADO ESS THIS SIDE I:H]ST/JFF LISP`ONLY <br /> PROGRMI Ert.FM11'MT1 SEARCH <br /> J ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDEROROUND TANK NSI)CLEANP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASH`FACXJTY <br /> OTHER CLEANUP SITE(NO"Om ❑ FOOD 1F :ILlTT ❑SOLID wA51E Y1-HICLE <br /> UNDERGROUND TANK(MONITOR1147'REMOVAL) 0 DOG KENNEL DAIRY <br /> HAZARDOUS WASTE CC�NQRATOR ❑ CHICKEN RANCH �PKC;TFEA116ENT I'LANT <br /> TIERED PP1�MnTEb FAC1l IT1' O IAOTELf"oTEL 0 PU111PE'.RTR'JCKNARDICHEMTOILETS <br /> ❑ TATTOOIBODY PEIRCING b FOOL/SP,k OTI-L.Ah Ij 195E.:ASE SPECIFYTION <br /> ABO <br /> 0 MEDICAL WASTE FACII- 7I ❑ PUBLIC%,rATER SYSTEM � OT}ISP.(PLC ASE aI�E CIFY AB DV6.) <br /> 1. List up to ten aCidresse ;in the space above. 2ielect the type(s) of files ft0i'll tha list above by,checking <br /> the approprlatelbox(es)� At least one file type MUST be selected. Eax to.i209 '16'}-A138_ or mpil t e <br /> address indicated abovlj <br /> 2. EHD will notify the applicant if any EHD files e,cist. An appointment for I�:view rriU be confirmed <br /> approximately five business days but no later than ten(10) days after re::e,ipt o'.application. Tha files <br /> will be held for III,ma)dmurn of five business days for review. Appointment,,should be scheduled <br /> accordingly. <br /> 3. A file that is actively tie ng worked on by EHD staff may not be ImmediaVel!e avl.liabie for revle!w. A new <br /> application may be sub Tiltted when the file is available. <br /> 4. Any file not returned in the same condition as,released will be reorl)anized'by I�HCI staff at th�i eupen='e <br /> of the applica4 Futur file reviews by the same applicant may require ::i$87.0 a diapusit prior to review, <br /> 5. *TENTATIVE appointor nt dates must be confirmed with END staff. <br /> 6. Applications re Ived a er 3:00 pm will be pnicessed the next business day. <br /> CONFIRMED APPOINTMENT E ATE TIME ! __- --- -- <br /> DATE CONFIRMED PHONE FAX rNIT1ALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> 191 M 116 eam u <br />