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4b,i1IJ <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> C0tDXf 1RONMENTAL HEALTH DIVISIO <br /> 3�4 EAST WEBER AVENUE, THIRD FLOOR* 00/070 <br /> � --" STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> API'LIC;AN �1/ BUSINESSIAGENCY (ll1Q�`I , <br /> .APPLICANT, <br /> LIG s d c C'4) .Sa0.s_ <br /> PHONE RD 29 Thb '7'I/C/ FACSIM]LE f / I Q <br /> TENTATIVE*APPOINTMENT DAIL TIME <br /> (Plea$e give 7 to 10 b%isinrss days tram datz of application submittal) f; <br /> CHECK BOX TO EXPEDITE REQU T-578.00 FEE—RECIUE ROCESSED IN 3 BUSINESS DAYS f ;, <br /> SIGNATURE OF APPLICANT DATE /C/ U <br /> • FILE ADDRESS <br /> ,I T � ti <br /> 1[ Jr a <br /> A04_64 Ud-41 0 <br /> II II Ie # <br /> - <br /> �- <br /> ENVIRONMENTAL HEALTH DIVISION FILES /� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT d Sot-10 WASTE FACILITY <br /> IYlli�' �� LUfI(r <br /> OTHER CLEANUP SITE (MON-LOP) d FOOD FACILITY ED SOLID WASTE VEHICLE <br /> URDERGROUND TANK(MON fTORINGIRE'MOVAL) M DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKNARDICWEM TOkETS <br /> 0 TATTOWRODY PEIRCING ❑ POOLJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM OTHERLEASE SPECIFY ABO <br /> Ear '91-5l I -Fi`e+tYtiDlf_I OAL� <br /> 1. List up to ten addresses in the space alcove. Select the typo(s) of files from the list above by checking <br /> the appropriate bvx(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. E1413 will notify the applicant if any EHD files exist. An appointment for review will ba confirmed <br /> approximately five 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. Appolntrnents should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHU 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 EHO 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 confirmed with EHb staff. <br /> 6. Applications received after 3:40 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> r <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW VATE <br /> Fli Do 14 &%/aims �� <br />