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SAN JOAQUIN COUNTYPUBLIC HEALTH % CES LNU Lou NUMU JI <br /> �IVIRONMENTAL HEALTH DIVISI <br /> ' <br /> _M4 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 '�$E EXP1fl ( fes' <br /> 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1?'"ARD l 'Z)pwS O. J <br /> BUSINESS/AGENCY0-�sInSE ErJV'1f+-awl P'L4-�1TRL Iry c <br /> ADDRESS _7-013 -7 Ve.vte+�no-K I�.� �;�Z�t e� 'Mptx-.SZZ� �A �t53 SL. <br /> PHONE Z09 S(�I OL93 FACSIMILE aO9 6(,9 <br /> TENTATIVE"APPOINTMENT DATE MA42-C fO, "LOOP 00/065 <br /> Please TIME <br /> ( give 7 1010 business days from date of application submittal) <br /> recel <br /> © CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE-REQUEST PROCESSED IN 9 BUSINESS DAYS MAR - <br /> SIGNATURE OFAPPLICANT��s� � L�q,�JOh( �100 <br /> DATE _03 <br /> FILE ADDRESS D <br /> _W lFT AnlS[UIL( �I�\ 5W tFT • . S �I P�Vtn �n 40 i,/t <br /> � rerZs s„� 2-n w Ct41h¢'rt=R w <br /> V <br /> COLO tABO USCIANA, I y S.l,lacul,t.1 wa — ' <br /> V '>`MGC.vJ!r-Cq fA.lp,-I� yAL �Qt'Q-'M.S rIn �avv >7e�v ro ci <br /> DE l01L_-MV(-y-STt7P Not of tov N ,2r� • <br /> v -rtcn�ls•N+,=;<_.1'rj �rorilL'sm W. CN 4 O <br /> oMEt.l,tf./ I o sr Ca, q 9 w. C.v di7-E'e' <br /> I nlrlc!�S rfl T C rrLnc K T gZS NAV Vq)VC t+l/ 1 1� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ® UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ <br /> ® UNDERGROUND TANK(MONITORING/REMOVAL) CI DOG KENNEL C3 DAIRY <br /> SOLID WASTE VEHICLE <br /> ® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY13 MOTEL/HOTEL ❑ <br /> ❑ TATTOO/BODY PEIRCING PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> Z. EHD will notify the applicant if any EHD files exist. An appointment for review will be 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. 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 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 same applicant may require a $78.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YES NO <br /> EN oo is avosmu REVIEW DATE - <br />