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10-20-=ioW 09:44RN r,* ra 4u Ja:,lig I _Il_ <br /> I{ SPG LUG HWULE <br /> SAN JOAQUIN NTCHFISERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> I (209)468.3420 <br /> I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT � BUSINESSfAG6NCY _,_, <br /> PRONE <br /> TENTATM E'p,pPDINTMGNT DATE ' f�n /� _ TIME <br /> (Please yivo 7 t0 10 buslmsa days frgm date of appacnuon Subnli") <br /> I <br /> 0 ORFCK BOX TO EXP41)ITE.REQUEST-0E7.0e FEE-REQUEST PAOCE SSED IN 3 Uu51NES3 GAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE ERD STAFF VSE ONLY <br /> PROGRAM 61.EMENTS SEARCH <br /> G <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 'HDERGROUNO TANR(UST)"CANUP SITE(LOP) ❑ HOUSINOABATEMENT ❑ SOLID WASTE FACILITY <br /> E THER CLEANUP SITE(NON�OP) ❑ FOOD FACILITY G SOLID WASTE VEHIC(,.E <br /> UNDERGROUNI?TANK(MONITORINGIREMOVALj n DOG KENNEL ❑ DAIRY <br /> ADOUS WASTE GENEKATOR b CHICKEN RANCH M rK4 TREATMENT PLANT <br /> CI TIERED PERMITTED PACILFTY O mCrfELIHOTEL PUMP)=A TRUCNIYARD(CHEM TOILETS <br /> 0 TATTOO)OODY PEIRGING 0 POOLSPA "" ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUDLIC WATER SYSTEM ❑ OTHER(PLEgSE SPECIFY ABOVE) <br /> .I 1. 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 file type MUST be selected. Fax to(2Q9,)464.0138 or mait ro the <br /> address indicated abova. <br /> 2. EHO will notify the applicant if any EHD files exist. An appointment for review will be confinned <br /> approximately five business days but no later than ten (10)days after receipt of application The flies <br /> will be hold for a maximum of five business days for review. Appointments should be Schedulad <br /> accordingly. <br /> { 3. A fila that is actively being worked on by EMD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> .I. Any file not returned in the same c❑ndition as relaaxed will be reargonized by EHb stuff at the w(ponse <br /> of the applicant, Future file reviaws by the same applicant may require a$87,00 deposit prior to review. <br /> i 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> i <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> { 511 <br /> Doll gwbw <br /> TUTAL P.02 <br />