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SAV JOAQUIN,COUNTYPUSLIC HEALTH SERVICES <br /> LJ I`- _ ) ENVIRONMENTAL HEALTH pM' N <br /> n L O — _ 304 EAS)'WEBER AVENUE,THIRD FLi rOR _ <br /> V STOCKTON CA 95202 <br /> J U L 1 1 1 (209) 4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> p <br /> APPLICANT( �A\l/Lill `/�J.P ., BUSINESSIAGEENN?CY Q' y c- <br /> ADDRESS 2,37 R11 J�/CQQ'p �" ( /(. Inc <br /> PHONE &I -7 ��CJQ /1 FACSIMILF�9- y� 7� /I/8 <br /> TENTATIVE-APPOINTMENT DATE TIME <br /> (Please eine 7 fa to bt i--y9 days from dam of appllcadon sub. ti j) - <br /> �lv�rs 3; 'r/ t mor <br /> ® CHECK BOX TO EXPEDITE REQUEST-S7(§.Q0)FEE- UEST PROCE3SEp IN 7 BUSINESS DAYS �p <br /> SIGNATURE OF APPLICANT \ DATE d () 0 <br /> FILE ADDRESS <br /> d OVZO <br /> 4t Ve <br /> ry�F 'vn, <br /> ryF :El <br /> titn <br /> CS �/ <br /> r Gil, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SCUD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON•LOPj ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> UNDERGROUND TANK IMONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL Q PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRDING ❑ POOL15PA O LAND USE APPLICATION SRES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I. 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 fila type MUST be selected, Fax to (209)464-0138 or mail to the <br /> 7ddress indicated above <br /> 2. 1rHD dvill notify the applicant H 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 rive business days for review. Appointments should be 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 file not returned in the same condition as released will be reorganized by END 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 END 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> er m I� a�rosoo <br />