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LIW <br />J..IL KL�U: LU, <br />^v1 SAN JOAQIL,�,ZOUNTYPUBLIC HEALTH SERVI' -S <br />ENVIRONMENTAL HEALTH DIVISION 's.! <br />304 EAST WEBER AVENUE, THIRD FLOOR -j-� <br />STOCKTON CA 95202 r� <br />(209) 468-3420 <br />BLIC RECORDS RELEASE APPLICATION <br />APPLICN l L c la. ! al a-'� BUSINESSIAGENCY <br />ADDRESS <br />PHONE FACSIMILE jAkl <br />9 TENTATIVE` APPOINTMENT DATE -5- � TIME ro <br />(Please give 7 to 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $87.00 FEE— REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE jz_+-cr /-3-01 <br />FILE ADDRESS <br />PA, <br />�,�r�ruuviniu��r�ran� <br />AultnlrlNL'�IIL'1U�= <br />I1�1G�fi=i' <br />==,Mi <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />,tZ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY <br />i r7 nr)r: KFNNFL <br />10 -SOLID WASTE FACILITY <br />❑ SOLID WASTE VEHICLE <br />❑ DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />s) of files from the list above by checking <br />ted. Fax to (209) 464-0138 or mail to the <br />fitment for review will be confirmed <br />ays after receipt of application. The files <br />Appointments should be scheduled <br />,O <br />,,W <br />v, <br />W <br />e immediately available for review. A new <br />e reorganized by EHD staff at the expense <br />ay require a $87.00 deposit prior to review. <br />staff. <br />Kt business day. <br />4E <br />4X INITIALS <br />DATE <br />