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NFELD(iR 4 002 <br />l9 9480621 • SLCiIdME:\'TD (a)003 <br />ano rocwli <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVIC zzi <br />ENVIRONMENTAL HEALTH DIVISION 13011.. 304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON OA 99202 <br />(209) 0.8 -WO <br />PUBLIC RECORDS RELEASE APPLICATION _ <br />5i-l�ll� Gu'L 6USIHE59/AGw;NCV�eIVI-i(�l�tiV� .__..�.�._�_`_ <br />�� �t�, Sac(Qntie�fc G l5g 71 <br />FACSIM4-,T(W) �5u <br />TENTATIVE* APPOFNTMENTDATe E )tai_ 1 � 3� CC�l�lit C!/r((� <br />(Pleue utve T to 70 buslnass days frau date orapplioaon submltlnl) <br />CHECK 90XTO EXPEDITE RrQ h$87 FEE—REOUr,r r20C6SSED IN a 8USINESS DAY:F ��4 2#3 <br />1/ <br />SIGNATURE OF APPLICANT LA I"j DATEv�z(��__ <br />-1' ENVIRONMENTAL HEALTH DIVISION FILES <br />,l1NDEROROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />SOLID INASTF �FAMI Y <br />nQ OTHFR CLEANUP SITE (NON -LOP) <br />❑ FOOD FA',:ILrrT <br />/ O SOLID'NAW Z VI=HICLC <br />UNDERGROUND TANK (MONITOFUNWREMOVAL) <br />O DOG KENNEL <br />DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKC, TFEAT TENT PLANT <br />TIERED PERMITTED FACILITY <br />❑ MOTEL/MOTEL <br />E PUFIPEIRTFt JCiXfYF,FIDICHEMTOILETS <br />❑ TATTOOMODYPEIRCING <br />O POOtisP.i -' <br />"LAFD NSEdI'PhdC,gT10N SfTE'a <br />❑ MEDICAL WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM <br />D OTFik (PLI:.ASE SPECIFY ABOVE) <br />1. List up to ten addresses in the space above. ,select the type(s) of files ftom tha )1st above by checKingl <br />the appropriate box(es), At least one file type MUST be selected. )_ax to,L20:6t�J138 01 mail t Fe <br />address indicated above <br />2. EHD will notify the applicant If any EHD files edst An appointment for review •Hill be confirmed <br />approximately five business days but no later than ten (10) days after re::e,ipt W. application. 'rhe filer. <br />will be held for a maximum of five business days for review. Appointment-,, should be scheduled <br />accordingly, <br />3. A file that is actively tieing worked on by EHD staff may not be Immediately av:•Ilable 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 recrganized'by I -HO suiff at tho wcpense <br />of the applicant Future file reviews by the same applicant may require r f 87.07 doposit 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 defy. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />TIME <br />PHONE FAX INITIAU3 <br />REVIEWED YES NO REVIEW DATE <br />