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.,11-30-21300 0E:24Fr9 FROM• TO • 11316H612430 P101 <br /> .�.1 11 HCiilY6U E,P ICL N,wukN <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304EASTWE$ERAVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> IQPLfBLIC RECORDS RELEASE APPLICATION <br /> IFFLICANT 344ee bN G OU51NESWAGENCY SE LO 12 7v �[ Y n�iLvct( SNC <br /> ADDRESS 3017 I<clFere- Poaa 5u -k. lav ZOL�C-(46 (.or4l -.4 CA 95ra7p <br /> DRONE q Y LW- D L1 OD 2--) lZ� FACSI&GLE W (0 81,21 - ON 3 4 <br /> TENTATrVE'APPOINTMENT PATE Mon l 2�tl O D TIME c�- kA - <br /> (Please give 7 m 70 Cusmess days Iron tlate of application su6minap rr�� <br /> CHECK BOATO EXPEDITE REQUESTVS-Z00 FEE-REQUEST PROCESSED IN 3 BU3LNFSS DAYS <br /> NOV JU r <br /> Itls6R CL�k�� DATE !/I30100 <br /> $)GNA7UREOFAPPLICANT <br /> . <br /> I _ <br /> TTOS SIDE EHO STAFF USE ONLY <br /> FILE ADDRESS <br /> i PROGRAM ELEMENTS SEARCH <br /> ti 441 ct'OLVA�r w s kph cA lF to 357- P 2 <br /> zl fiD C1+ar{c- lbs S'r ukaw,, C4 f 4R.CD - - <br /> 3': 5oss C cr Way , s-kv C6,Vr , r actio 3s� rL2 <br /> vl 515 CL.av --1•J -1wi 'Tr jmaew*.P" <br /> �„ 5 . f2o1 T <br /> 51 GYo Ctwvac. Shall ,PN <br /> v 1 1'i 1 L'.n toll+ 1�vc �i, IPr Fbrn,er Ski lfulc(tma, e r�' 3 2 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLM WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SQLID WASTE VEHICLE <br /> 6 UNDERGROUND TANK pdONITORING1REMOVAL) e7 DOG KENNEL M DAIRY <br /> Q HAZARDOUS WASTE GENERATOR O CHICKEN RANCH in PKGTREATM6NTPLANT <br /> TIERED PEWASTED FACILITY O NCTEUHOTEL CI PUMPERTRUCKPIA"ICHENT04EfS <br /> TATTOOMODY PEIRCING ❑ POOL/SPA ' ❑ LAND USE APPLICATION SITES <br /> E1 MEDICAL WASTE FACILITY in PUDLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses in the space above. $elect the type(S) of files from the list above by checking <br /> the appropriate-box(es). At lea-51101710 file type MUST be selected. Fax to 1209) 454- 138 or mal to the <br /> address indmatl)d above. <br /> 2. EHD Will notify the applicant if any EHD files exist. An app0intMent for review will be confirmed <br /> j apprOXlrnRtely five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> �. <br /> A file t at iy.A file that is actively being worked on by EHD staff may not he immediately available for review- Anew <br /> i application may be submitted when the file is ava)fable. <br /> 4. Any file Ilot returned in the same condition as released Will be reorganlred by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$s7.D0 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed With EHD Stgff_ <br /> 6, Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />