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u t Ul i= ?1 uiYD0R Efi ,id TE _ <br /> rkG0C II 4td3 F !:'i <br /> t'1t+wt�HUldbch /7 <br /> SAN JO�JIN COUNTYPUBLIC HEALTH S ICES <br /> I IRONMENTAL HEALTH DMSIO <br /> A P R 2 i Z001 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON GA 95202 � <br /> (208) 4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. \r BUSfNE55lAGENCY &T" ('--ryT������ C <br /> ADDRESS ���-, <br /> PHONE 2_4'7; �.�IQ7 FACSIMILE <br /> • <br /> TENTATIVE'APPOINTMENT DATE TIME Mee <br /> �-y (Please give Y to iD husi[less days from date of application submitfal) AFR <br /> u CHECK BOX TO EXPEDITE REQUEST <br /> $87.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTt Uri`lG( � nYt9�! DATE e. =;4—(fit <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 'A ot 6w., <br /> .I <br /> X381 — <br /> 272`f, ZZZO <br /> 2;—'Z 2_22G, 5-2-7 <br /> `Z Z Z ZZC' <br /> 7°/ eH�,✓NEL S59 <br /> ("/ cma,ti/a2 ENVIRONMEN1fl j1 T 1ViSA/JNF11 S fi /�/�� D <br /> G �O b 7 iii Z- Eco T <br /> NDERGROUN❑TA K(65Y1 CLEANUP STYE(LOPI""8`�FlF7USfllG�STEMENT 'p—SOLID WA,3TE F <br /> �.�THER CLEANUP TE(NOWLOP) ❑ FOOD FACIL17Y ❑ SOLID WASTE YEHIC <br /> zPJJNDERGROUND 7 NK(MON ITORINGIREMOVAL) ❑ DOG KENNEL IJ DAIRY <br /> I'dd HAZARDOUS WAS E GENERATOR CJ CHICKEN RANCH ❑ PKG TREATMENT PLANT APR 2 7 7T <br /> C] TIERED PER.-A1TT FACILITY CI MOTEL/HOTEL ❑ PUMPER TRUCIUYARDICHEM TOILETS <br /> ❑ TATTOOIBOOYP RCWG ❑ POOLISPA - Pa LAND USE APPLICATION SITES <br /> ❑ MEDICALWAST F CLl ❑ PUBLIC WATER SYSTEM CJ OTHER(PLEASE SPECIFY ABOVE) <br /> z22_ F <br /> 1. List up to ten adcrresses 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(209)46"138 or mail to the <br /> address indicated above_ <br /> 2. EHD will notify the applicant if 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 behold 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 EHD staff may not he 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 EHD staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed wM EHD 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 nATP <br />