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LHU LUG NUMULH <br /> SAN JOUIN COUNTYPUBLIC HEALTH <br /> � VICES <br /> VIRONMENTAL HEALTH DIVISI <br /> 304 EAST WEBER AVENUE,THIRD FLOOR SC eyPtfl \ rt7_ <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ��cNARD \ ,JA`^�S O� BUSINESS/AGENCY G'L° -'-)'APSE <br /> ADDRESS 2a1 -7 ve.vt� NtaK IkJ Z'- ,Q�;*: C_Q SCJ 5 1, <br /> PHONE 2� 5(A 0Z,13 FACSIMILE c�a l &9 osA r 00/065 <br /> TENTATIVE"APPOINTMENT DATE Mk(2.0A l(J ''000 TIME <br /> (Please Hive 7 to 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE 03 7 OD <br /> SIGNATURE OF APPLICANT��� <br /> FILE ADDRESS <br /> SW tj%poP_� rl'E�\ "_SW vFT ru `($1 Pc\+c. �'T� ISO Ale _:5s, J /moi• <br /> �LOMq��TC�`.:-Cr1,N/�. 1'-�1.) `�.L.t�.1�u1.t.1 W�� �5_-�•�' �- — <br /> ��,��.y:f.-f� Ptita�c' 2A� �=A�ra S <br /> (III n1AV Y <br /> Df�UL�T2UG.KST>7P IoO� or \0'-1S <br /> T1�An15 rv'• -.t,I o.1 <br /> o rpt C\.L.I I sr, Ccs. CJ39 W, C�A�R-1 "►� a ,c T <br /> Z rttt�--��."r"►a -rt_M;,1�- T�Z X32.5 NAVY V9 V G <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Si UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> IR OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ® HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 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 (209) 464-0138 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 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 EHD 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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> FTNFIRMED APPOINTMENT DATE TIME <br /> E CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01105100 <br />