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Aa 25. 20u3 I,20pM, CON EARTH TECHNOLOGIES No -4748 P - I/I <br />�Ta RecBVIM 010 Lac NUMM9 <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />uG 2 5 ZU03 304 EAST SWEBER TOCKT NCA 9 THIRD FLOOR NO <br />STOCK70N CA 95202 <br />(20D) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPL:CANT� � <br />ADDRESS ��� a&e4d J.-,BUSWESSIAGENCY 6Axl ~kjo"�faali <br />s cllmki- <br />PHONE ?VL FACSIMILE 2�—Q5Za5j1D <br />TF_Ni'ATIVE' APPOWTTea DATE a_g_ 13U4Y��� 4 TIME. TE ' <br />(Please* give 7 to td business q from date of appllp0on submftfaQ � ■ / <br />CHECK BOX TO EXPEDITE REQUEST - $87A0 FE>; REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />03 3dti�'>> <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />26 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) CI FOOD FACILITY SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br />TATTOO/BODY PEIRCING 0 P001-.jSPA - ❑ LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY X PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFYABOVE7 <br />A) ��J <br />1. List up to ten addresses in the space above. 'S le "tileL types) of flies from the list above by checking <br />the appropriate box(es), At least one file type MUST be selected. Fax to (209)_464-01 IS or mail to the <br />address indicated above. <br />2. END will notify the applicant if any END 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 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 $87.00iApr1Qr( 6q- a <br />5. 'TENTATIVE appointment dates must be -confirmed with END staff- y :, <br />6- Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE _ _ TIME <br />