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A-1 Q7t 3 Lty-T) F+1JM TO 19163729065 P.®1 14 <br /> WAN u r t w . . EMU Luo humv <br /> SAN JOAQUIN.COUNTYPUBLIC HEALTH SERVICES <br /> JUL 2 3 ZOU1 ENVIRONMENTAL HEALTH DIVISION C �� <br /> 304 EAST WEBER AVENUE, THIRD FLOOR J <br /> E(vVIFt q , Eiu ;ictiLj H STOCKTON CA 95202 <br /> PER!'v11T/SERVICES (209)4es.a420 e <br /> �tPUBLIC RECORDS RELEASE APPLICATIONf <br /> APPLICANT ('tee,,0 e/ t: -�-.+ r L BUSINLSSfAGENCY !( <br /> ADDRESS OJ r Al V CA WCJ ` <br /> FACSIMILE - C?06-1— <br /> d <br /> TENTATIVE"APPDIPTMENT DATE 7 �7� TIME -/ ?o <br /> (Please 0ivv 7 to 10 bustna"days troll date 000f7'a tcatioo su4rtl nen% <br /> CHECK BOX TO EXPEDITE REDLUBST-$S D FEfi ST Pl&O�SFD IN 0 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> LLE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 0 D <br /> 00 Low,-, <br /> OD Da - <br /> 0 o r 1 <br /> 0 c <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND,TANK(UST)CLEANUP SITE a.OP) ❑ HOUSING ABATEMENT - At,S01.10 WASTE FACILITY <br /> OTHER CLEAN SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MOWTORiNWREMOVAL) ❑ 006 KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE OFNERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> RTI TIERED PERMITTED FACILITY � ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDN:HRM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ' O LANDUSEAPPLICATIONSITES <br /> ❑ MEDICAL WASTE FACILITY j( PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> t• List up to ten addresses in the space above, Select the type(s)of files from the list above by checking <br /> the approprlate bodes). At least one file type MUST be selected. Fax to(2Q9)464-01311 or mall bo the <br /> Addjess Indicated lbove. <br /> 2. EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed <br /> approximately'five business days but no later than ten(10)days after recelpt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should he scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by END staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any the not returned In the same condition as released will be reorganized by ENP staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a S87.Da deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Appllcatlons received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> ()ATE CONFIRMED PHONE FAX INITIAL.$ <br /> REVIEWED YES NO REVIEW DATE <br /> N as 0"7M <br /> TOTPL P.01 <br /> rnmv-aoerreu - cans 712, PIC Ywa 1C:91 1010711n <br />