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.:-St_aTLl.:d«iJ � kN[:t.W NLMut1: <br /> SANT JOAQUIN COUNTYPUBLICW HEALTH SER ICES <br /> APR - 5 Zu 1 ENVIRONMENTAL HEALTH DIVISION <br /> a04 EAST WESER AVENUE.THIRD FLOOR <br /> STOCKTON CA 95202 rr-a ' <br /> (209)46$-3420 <br /> P11 PLIC RECORDS RELEASE APPLICATION <br /> x iCANT_ f ci a'Yt 1 u,s r3 [!' su �[r ,{ �, <br /> s M/A�ENCr A n �� t <br /> PHONE f(:�"1 �•�i 7. � rSS �7��FACSIMILE A-1 Aft <br /> ATEVE'APPOWTIAENIT DATEto a i ilhlE _ Z r\ <br /> iF'Is�sc gird 7 to Ii7 busitidu days trod dWg 4f appE1=;ian suhmittnq <br /> EicCiC BOX TO E7CPED1 rL BEQUEST-*57.+00 FEE—RE4OIESY FROCESSED IN 3 5USIHESS DAYS <br /> SIGNATURE OF APPLICANT ��� �n--��~ �^ DATE. ,� ) <br /> i <br /> FIL G ADDRESS THIS S10E Eiiu BTAIrF[SSE oAtL.Y <br /> I PROGrr1+M ELEMENTS SEARCM <br /> 771 CLI <br /> d <br /> ENVIROIAMENTAl.H2ALTH IDIYISION FILES <br /> UNDERGROUND TANK(UST)GL&jiUP SITE(LpP) Q HOUSING ADATEIMENT L;l 5011D WASTE FACILfrY <br /> CA OTHER CLEANUP-WTe(NQN-LOP,) G FOOD FACILITY II 5005 WAVE VEHICLF- <br /> UNDERGROUMP TANK(moNriOF U WREMOVAL) C3 POG KENNEL iD DAIRY <br /> fi3 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG WtgATMENT PLANT <br /> O TIERED PEt7MI 1 cED FACILITY i 0 MOT"3LMOTEL Cl BUMPER TRUCKIYAAWCKE14 TOILETS <br /> 0 TATrOWBODY PEIRCING i I3 POOLJSPA • 0 LAND USE APPLICAVON SITES <br /> 0 M&DICAI-WAVE FACILITY EI P1l01.4 WATER SYSTEM 0 (>TTiER(PLEASE SPECIFY ABOvE) <br /> I List up to ten addresses in the space above. Select the type(s)of files from the list above by Checki.ig <br /> the appropriate box(6). At least one file We MUST be selected. Fax to tZ179)4f4-0138 or mail to tele <br /> 2ddress indicated above. <br /> 2. EHD will notify the a�p!lcarat if anyy END fides exist. An appointment for'review will be confirmed <br /> apprayirmately rive business days but no later tharl ten(10)days after receipt Of applicatian. the fifes <br /> Waill be helcl for a niazlmurrl of five!business days for review. Appointments should be sch-+dulad <br /> acGOrdingly. <br /> 3. A file that is actively(being worked an by EHD staff may not be Immediately a,iailable for review- A new . <br /> application maybe sslbrnitted when the file is alvailalble. <br /> 4. Any ifie trot rcturnedlin the same cnnditlon as released will be reorganized by EHD staff at tha expense <br /> oa the applicant. Future file revit3WS by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'i ENTAf!VE appoin went dates Mu-jt be confirmed with EHD staff. <br /> b. Applications receive8 after 3:00 Pm Will be processed the next bu$inass day. <br /> CONFIRMED APPOINTMEW DATE TIME <br /> DAT E_CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES N® REVIEW DATE <br /> EM 00 14 "ffl7loo TOTAL P.01 <br />