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0 0 <br />DATE RE'-EiVZD END <.GG IYDM&ER <br />SAN JOAQUIN COUN <br />TYPU8LIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION � (,sy <br />J 304 FAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />6 1 b (209) 4e8 -34M. �U <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT Int a.r �1 _ a SUSIXESWAGENCY ! G=0 r rar` 1 <br />ADORESS <br />rro�vt 1c t`r'c�rt ��[ CSA 9 J �s <br />pHaNc 2.01 -- 2-A-4 - <br />TENTATIVE" APPOINTMENT DATE TIME <br />(Please give 7 to 10 business days from date of appracaaan suhmittal) <br />'--' CHECK SOX TO EXPEDITE REQUEST - $87.00 FEEL REQUEST CE3 IN, 3 BVVNESS 0AY3 <br />SIGNATURE OF APPLICANT/� DATE 3 I -7-1 <br />T&X- SIDE EMI) STAFF U:W- ONLY -- <br />r iRMW EJ <br />• Fel • J • Y -_ .��:���� <br />ENVIRONMENTAL HEAL.7H DWIS)ON FILES <br />&/UNDERGROuND TANK (UST) CLEANUP SIVE {LOP) ❑ HOUSM ABATEMENT 0 SOLID WASTE FACILITY <br />GrOTHER CLEANUP sn E (NoN.Lop) ❑ FOOD FACILITY o sato was -re vcHcLE <br />�iNDER,GRauND TANK (AmONrroRLNcIFm rAaVAL) ❑ QQG pmNHEL. E�-6l" <br />EVIHAZARDOL IS WAS'T'E GENERATOR Mr—cniCKEN RANCH 0 PKG TREATNENT PLANT <br />❑ TIERED PERMITTED tACILrrY ❑ MOTE.LfHOTEL ❑ PUMPER TRUCKIYAPDi HEm Toium <br />El _T TTOOMODY PEIRCING O PobLiSPA ❑ LAND USE APPI.W-84 ON Snl�$ <br />IR MEDICAL WASTE FACAjTY Ci PuaLic WATER SYsTem 17 G'L'HER ('LEASE SPECIFY ABOVE) <br />1. List up to ten Addresses in the spaca above. Select the types) of files from the list above by checking <br />the appropriate box(")_ At least one file typo MUST be selected_ Fax to 209 -(138 or mail to -the <br />address indicatedabove, <br />2. E:.HO will notify the applicant If arty EHD 1110-5 exist An appointment for review will be confirmed <br />approximately five busln s days but no tater than tort (10) days after receipt of application. The files <br />will be held for a maximum of five business days for reviow. Appolnttnelnts should be scheduled <br />accordingty. <br />3. A file that is actively being worked on by f~HD stAff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br />of the applicant Future file reviews by the %amO applicant may require a $87.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />3. Applications received after 3:00 pm will be Processad the next busiltess day. <br />.'ONFIRMED APP01rrrMFjgT DATE _ _... _._ TIME <br />)ATE CONFIRMED PHONE FAX INITIALS <br />