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"-,10.4/21/200 07:30 FAX 209 9480621 0002�002 <br /> ENI]4W NVMeER <br /> JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION �z <br /> . 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ppp 9 1 2003 I <br /> STOCKTON CA 95202 <br /> (209) 468.3420 <br /> (dP-r WJIT/EE IGEL PUBLIC RECORDS RELEASE APPLICATh.)N <br /> v'"Rf iT SERVICES <br /> J� ���'✓✓G'Z BUSINESSIAGENCY e'C�/`S' -E r <br /> APPLICANT /G�/P CA <br /> ADDRESS <br /> FACSIMILE <br /> PHONE r O n TIME (/J <br /> n 7 <br /> TENTATIVE'APPOINTMENT DATE 1�' <br /> date of applieaVorl submiliat) <br /> (Please give 7 to 10 business days hofs <br /> ,; f a, , <br /> CHECK BOX TO EXPEDITE REQUEST•$87.00 FEE--REQUEsT PROCESSED IN 3 BUST Y=` / ,/� S <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIDE E ND STAFF USE ONLY ■ �, <br /> PROGRAM ELEMENT:;SEARCH <br /> J ArGL. Rve.d lMfw -"c Rood PN I f-fcd-06 - <br /> y6SO ewc G <br /> R-056d St.tir , <br /> — 1 <br /> il ASI <br /> - N <br /> N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UND ❑ HOUSING ABATEMENT �SOLIJ WASTE FACILITY <br /> OTHERC CLEANUP <br /> TANK(UST)CLEANUP SITE(LOP) O FOOD FACILITY Q SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NONI.OP} G XENINCL DAJRY <br /> 4UNOERGROUND TANK(MONITORINGIREMOVAL) ❑ CH CKEN RANCH O PKC TREATMIZI'n'PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPERTRUrWARDICHF.M TOILETS, <br /> TIERED PERMITTED FACILITY ❑ FOOLISPA �LV71:]USE APPLICATION SITES <br /> O TATTOOIaODYPEIRCING p�PUBLIC WATER SYSTEM q OTHI R(PIFA5E SPECIFY ABOVE) <br /> MEDICAL WASTE FACILITY / <br /> 1, List up to ten addresses in the Space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Foto.209L�,0138 orrnall to pj. <br /> address indicated above. ill be confirmed <br /> 2• EHD will notify the applicant if any EHD files exist. An appointment to:rrvlelvw <br /> approximately five business days but no later than ten(10)days after <br /> er ents should licached fedfl�j <br /> On <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediatbly available for review. A new <br /> application may be submitted when the file Is available. <br /> I be reorganized at <br /> he <br /> tion as <br /> q. Any filereturned Future file reviews by the same <br /> eased Wit <br /> of the appplicantapplicant may require U$8T.00(IDeposit prior t xreview. <br /> ATIapointment dates must be confirmed <br /> 5. SEN cat ons recl <br /> th EHD Staff. <br /> 6. APP eived after 3:00 pm will be processed essedthe next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX IN71AI <br /> REVIEWED YES NO REVIEW DATE = --•_ <br />