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tl(/LL/Lf7174 1�:53 Lqy-517- �5 MUl)E!:.I U A I l <br /> SAN JOAQUIN CODNTYPUBLIC HEALTH SERVICES Ltd„ <br /> ENVIRONMENTAL HEALTH. DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> - c u STOCKTON CA 05202 <br /> JUL (20D) 468-3420 <br /> N94PUBLIC RECORDSRELEASE APPLICATION <br /> APPUCAf�I"�1 EN I <br /> G !` ��`'� eUSINC55fAGCNCY �- <br /> ADDRESs ((�- olw, "V4 <br /> PHONE � � ` 7.Z� 1 FAC 1MILE 4'r <br /> 'T'ENTATIVE`APPOINTMENTDATI TIME aff�d <br /> (PIC-1;c give 7 [o 10 buzi,CA.days train dale oI-ippiie;.lion:-Tb ltai) <br /> d QMLA:C c aOx TO,EXprDITE IAEQUCST-$07.04 FE[ REQUL=ST PROCLSSED IN 3 13USINCSS DAYS <br /> SIGNATURE OF 4PPLICANT DATE <br /> FILE ADDRE55 THIS SIDE HHD STAFF USE ONLY <br /> a PROGRAM L•LEMENTS SEARCH <br /> i C-. �t.4k„�,►. fav~ ce, ms s / �/ <br /> 449 A QS' tam -�3 j26 f/ <br /> Ile M A € Ivy ,,��-c c /V o /,"-Z r <br /> t`{ t 4 <br /> 'a <br /> ENVIRONMENTAL HEALTH 1JEVIs10N FILES <br /> 16140CRGROUNO TANK(UST)CLEANUP SITZ:(LOP) 0 HOUSING ADATEMUNT 0 SOLID WASTE FACILITY <br /> O OTMER CLEANUP SITE(NON-LOP) ❑ FOOD FACIUTY 0 SOLID WASTE VEHICLE. <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> C] HAZARDOUS WASTL- GENERATOR 0 CHICKEN RANCH 0 PKG TA ATMENT PLANT <br /> 0 Tir-REO PERMITT4D FACILITY n MOTELINOTEL 0 PUMPER TRUCKtYAROICHCMTOILETS <br /> to TATTOQ/1300Y PUIRCING ❑ POOLISPA 0 LAND USE;APPLICATION SITES <br /> 0 ML-DICAL WASTL FACILITY 0 PUDLIC WATER 5Ys.TEM ❑ OTHCR(PLL-ASE SPECIFY ABOVE) <br /> 1. List up to ton addressos in th6, space above. Select the typo($) Of files from the list above by checking <br /> the appropriate box(es). At(cast one file type MUST be selected. Fax to 203 464-0138 or mail to the <br /> address indicated above_ <br /> 2. EHID will notify the applicant if any EHO files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application.,The files <br /> wili be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordinrdly, <br /> 3. A file that is actively being worked on by EHD staff may not ba immediately available: for review. A now <br /> application may bQ submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will ba reorganized Uy EKD staff at the cxpanso <br /> of the applicant. Future file reviews by the same applicant may raquire a X87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHO staff. _ <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT HATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> sn oo +� aorioo , <br />