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t,� r • <br /> VVVVVV JAl4 KµC�•C'a Lna KN:'��� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,TI+Rl)FLOOR <br /> 1� STOCKTON CA 95202 <br /> (209)468.420 <br /> -PUBLIC RECORDS RELEASE APPLICATION <br /> CI g:5)NJ�tS&�AG6CY ^VAPPJGANT Dd• ra ,JOG4A; <br /> ADDs . <br /> �Y3Za _ <br /> PHONE 0.20"/POA FACIAMILE sem, , C1 E3 8-5 <br /> TENTATIVIi'APP0IxTmENT0ATb TIME 9'&)o <br /> (PIP�e•flrv�7 eo to pt:ainesa vers tram We at oppllca:lon nub:aittao <br /> Cy.ECK BOX TO UPEXTE REQUEST FEE r1UEST PROCESe.D IN 16U.iINESS DAYS <br /> SIGNATURE OFAPPLICAMT DATE <br /> FILL ApDRE55 THIS STDG EHO STAFF USE ONLY <br /> PROGRAM ELEME 6EARC <br /> 7. tw 1-15 3 S2L <br /> s <br /> Vie <br /> I ; <br /> F I <br /> ) <br /> 1 <br /> I <br /> I I <br /> _ ENVIRONMENTAL HEALTH DIVISION FILES <br /> e LNDERGRMNa TANK(UST.)CLEANUP SITE Q,AP) O HOUS)NU A2ATEKENT a 5Q.:Q VVA'TE FACILITY <br /> G jJT1N'_A CLEANU?SITE(NON-LOP) ❑ FOOD FACIL)Tr �=+ $OLID WASTE VEHICLE <br /> f2'UNQNZGROJNDTANKIMONrrOFUlG/PEI.I0YAL1 d DOG KENNEL W DAIRY <br /> HAZARDOUS WASTE GFEIF,RATOR C) CHICKENRArNCH `J' PKG TR£ATaTEhT PLANT <br /> C TIERED aZRMrrED FACllrTY G MOTFLMCT-_L C PUH?ER Tp,Ut7()'rARDICHEht TOILETS <br /> TATTOOUOCY PEIRCING O POOLSPA D LAND USE APPLICATION SITES <br /> MEDICAL wi%STEFACt:1Tr n FUSLICYYATERSYSTEM c: O7HERIPleA4ESPE0IFYABOVE) <br /> t, _lot up to ten addreaaes in the.space above. Seleot the typ;r(s)of files from the Est above py chocking <br /> the apprupriate oox(es). At least one fila type MUST be selected. Fax to 12091464-0128 oi•Mail to the <br /> add ess indicated abwym <br /> 2. EMG will notify the applicant if any EHD files exist. An appafntment for review vrili be eon4irmod <br /> approxiniately five buainess days but no later than ten(10)days after rce:ipt of application, The riles <br /> will be held for a maximum of five buslnoss days for review. Appointments should be schSduled <br /> accordingly. <br /> 3. A file that IS activaly being worked on by i:HD staff may not be irornediate)y available for review. A new <br /> spplic_aUon may be submitted when the 1rIe is xvaitabla, <br /> 4. Any the not returned in the✓;arae condition as released will ae reorgantxed by ENO stay at the oxpvnue <br /> of I:ne applicant. Future file reviews by the same applicant may require a jr$,00 deposit prior to rev'.ew, <br /> 5. TENTATwE appointment datea must be confirmed with EHO staff. <br /> 6. Applications received aTter 3:00 pm will be processed the next business day. <br /> I CONEIRIAED APPOINTPAE:N'TDATE _ TIME i <br /> DATE CONFIRMED - _ PHONE FAX INITIALS }I <br /> REVIEWED YES NU REVIEW DATE <br /> TDTF'rL. P.el <br />