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_11-30-20M 00:22FT1 FRO* TO 0 19168612430 P.ul <br /> .r.l I L F+Lf.LIYhU EM LOG Nwtt:Eti <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> F 304 EAST WE13ER AVENUE,TWRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)568-3420 <br /> I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> FFLICAXT A k4--r 14,A�f- UU51NESWAGENCY <br /> AQDR�SS 3a2�_ kcl n. lzeaaa �t 1dv �u•�c etc t��a(vt C/i 95 (a7 0 <br /> t1Oi1E i !- a'ldo FACSINLE 2/ (0 Kai - yu 3 a <br /> TENTA_f[VF_'APPOINTMENT DATE Mon 1 �l r P1> TIME `jj'fu 4A ` S=4,o ��rl • <br /> (Please BIVG 7 to 10 business days from date Of appYication submtttal) <br /> NOV30 � <br /> CHECK BIOA"[O eXpEDITE RERUE5T-5137.00 FEE-REQUEST PROCESSED 1N 3 13USIHE55 DAYS <br /> SIGNATURE OF APPLICANT , — DATE ll�. fPO <br /> 1 <br /> I"ADDRESSTWS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> II 11N1 L4arhr W 5}� k_�o� CA <br /> '7 SM to 35,;)-4 2 - <br /> �j <br /> LA t> (_1nar�c WAy, k�vh CR F ,ri+ 4�CD -- <br /> 3�,tc� <br /> 3; rj��d r}cr LJ» 5} oh CA _ <br /> � �fwn 5 . iZod rl 3Sa4 (Z2 <br /> y I fS <br /> o I Li L',n Co(Y, AV- S �+ G4 �rrhGr t7cl �n�abatn e YI / �� 2'\ <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �f ❑ Spun WASTE FACiUTY <br /> f� UNOaERGR6IJND'fANK(LIST)CLGANUp SITE(LOP) ❑O HFOODIFACILITY ENT O $DUD WASTE VEHICLE <br /> O OTHER CLEANUP SITE(NON-LOP) ❑ p,'11RY <br /> UNDERGROUND TANK IMONriORINGIREMOVAL} ❑ DOG KENNEL Q d FKG TREATMENT PLANT HAZARDWS WASTE GFNERA70R D Gt11Gt�t>tANCH <br /> 4 TiER�PE121VlITTEQ FACILITY O h{OTEL1HaTEL. Q PUMPER TRUCK1YAFt11/CHEtit T04��S <br /> ITES <br /> 6 TAT7oo1BODY PEIRGWG ❑ p0OLfSPA C3 LAND 113E RASE SPECIFY <br /> ABO <br /> rb MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER{PLEASE SPZwCIFYABOVE) <br /> I <br /> �• List up to ten addresses iri the space abpve. $elect the type(S) of files from the list aboVo by checking <br /> the appropriate box(es). At least one Fie type MUST be selected. Fax to(2a9) aha-D738 or al to me <br /> address indicated above. <br /> 2. EHD will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approXil7laitely five busins~ss days but r10 later titan ten(10)days after receipt of application. The files <br /> a will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> • A file that is actively being worked on by EHD Staff may not be immediately available for review. A new <br /> i application may be submitted when the Me 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$87.00 deposit prior to reveew. <br /> $. 'TENXATIVE appointment dates must be confirmed With ENG staff- <br /> 6- Applications received after 3.00 pill will be proCessed the next business duty. <br /> ETIM E <br /> CONFIRMED APPOINTMENT DATE <br /> ATE CONFIR.NI)"d PHONE FAX INIf1ALS <br />