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JOAQUIN.COUNTYPU;BLIC HEALTH SERVICES <br /> of ENVIRONMENTAL HEALTH I)M;&N <br /> Lq)LC -" . 0 _ 304 EAST WE13ER AVENUE,THIRD FL=R <br /> STOCKTON CA 95202 <br /> J U L 1 1 _'Is 1 (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> BUSSINP,&SIAGEENNGY-6 (d {G(ncloj <br /> ADDRESS d� CJK� C_1C-Ld� � l.lZ 7 rSl�l�J� <br /> PHONE coq - lJ FAGSIhAILE � 7 L �/ <br /> TENTATIVE*AP ow-ru1-NT DATE _ TIME <br /> (Pleaaa Hive 7 Io 10 bLuine�days from data of application sub"itvi) <br /> J� �/tJiTS 3 <br /> F, <br /> K�+ CHECK BOX TO WED REQT <br /> UEv' -ST 0 FEE-R VEST PROCE3�IN Z BUSINESS PAYS QUI <br /> SIGNATURE OF APPL,IC NT � � M .t�� DATF- d n d I <br /> 1 i liI I ■ <br /> \I FILO ADDRESS O <br /> a �O <br /> 011 i <br /> v - <br /> �' 1�I1Qan+� G Sero_ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> XUNDERGROUND TANK(U3T)CLEANUP S17E(LOP) 0 HOUSING ABATEMEN r 0 SOLID WASTE FACILITY <br /> .?{ OTHER CLEANUP SITE(NDN-LOP) a FOOD FACILITY O SOLID WASTE VE111CLE <br /> ,UNDERGROUND TANK(MO rTORINGIREMOVAL) Cl DOG KENNEL 0 DAIRY <br /> XHAZARaous wA57E GENE TOR 0 CHICKEN RANCH U PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILTry O MOTELIHDTEL E2 PUMPER TRUCKIYARDlCHEMTOILETS <br /> ❑ TATTOOIBODY PEIRCING CI POOU5PA CI LANE]USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY El PUBLIC WATER SYSTEM d OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses in the spare above. Select the type(s) of files from the list above by checking <br /> the appropriate wges). At least one fila type MUST be selected. Fax to (209)454-3138 or mail to the <br /> address indicated aboy% <br /> 2. ]EHD*ifi notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately fie business days but no later than ten (10) days after receipt of application- The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application mlaya submitted when the file is available. <br /> 4, Any file not retu ed in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be conftrrned with EHD staff. <br /> 6. Applications rec ived after 3:00 pm will be precessed the next business day. <br /> CONFIRMED APPOINTENT DATE __ _ _ TIME <br /> DATE CONFIRMED 7 PHONE FAX INITIALS <br /> REVIEWED YE NO REVIEW DATE <br />