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ATC RE EIVED ?' �1Q,�QQ NVN�ER <br /> -JOAQUIN COUNTYPUBLIC HEAL ERVIC <br /> ENVIRONMENTAL HEALTH D1 .JN <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 lag <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 14 <br /> i f 1 j I's l�'f' b/ S IV GAC�n pC.� l'1 J0.24"" ' <br /> APPLICANT�V`i _ y+r� C�► BUSINESSIAGENCY V 5 I l <br /> ADDRESS u ®mal d 'i<• <br /> 69)13 7 -2 31.6 FACSIMILE <br /> PHONE(a <br /> .. - .. .'7.4,,, <br /> ..—e <br /> TENTATIVE*APPOINTMENT DATE As l 1 M <br /> e .&j. F TIME. /A.,� Ste' <br /> (Please give 7 to 4 busjfTPR <br /> Ilcation submittal) OVACHECK BOX TO EXPEDITE REQUEST-S . 0 - N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT C2� rLeV Ia DATE 6 '� <br /> .y <br /> FILE ADDRESS THIS SIDE EHD STAFF US EO <br /> PROGRAM ELEMENTS SEARWO <br /> `/Zs At-rPl E1 '1?.14.. C:X+-- •I•$-Zoe <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> O UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT 11 SOLID WASTE FACILITY \ <br /> Q OTHER CLEANUP SITE(NON4.OP) <br /> 13 FOOD FACILITY D SOLID WASTE VEH1CrLlr <br /> 17 UNDERGROUND TANK(MONITOR1NGIREMOVAL) O DOG KENNEL C] DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR D CNICKEN RANCH ® PKG TREATMENT PUNT <br /> ❑ TIERED PERMITTED FACILITY ® MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS e, <br /> ❑ TATTOOIBODY PEIRCtNG ❑ POOLISPA 9 LAND USE APPLICAtION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. Ust up to ten addresses in'the space above. Select the type(S)of files from the list a44ve by checking <br /> the appropriate box(es), At least one file type MUST be selected. Pax to(209)464-01H at mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD flies exist. An appointment for review will be:ponfirmed <br /> approximately five business days but no tater than ten(10)days after receipt of appllration. The flies c c <br /> will be hold for a maximum of five business days for review. Appointments should b13`schaduled ?S` <br /> accordingly. <br /> 3. A file that is actively-being worked on by EHD staff may not be Immediately available for review. A ne <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorgaritxed by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5. "TENTATIVE appolntment dates must be confimied 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 /> Z/Z abed !85:5I ZO-LI-ABVI !Z6ELLS660Z !sNuOM#3Iiend#NOJ-NDOlS#d0#A.LID :AG It,189 <br />