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DATE RECEIVED <br /> SAN JOAQ, ,,q COUNTYPUBLIC HEALTH SEhs/ICES LO AMBER <br /> ENVIRONMENTAL HEALTH QMSION <br /> T WEBER AVENUE, TH1 <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIO <br /> AY 2 <br /> APPLICANTGLP�BUSINESS/AGENCY Q c <br /> ADDRESS U CJ tL <br /> w <br /> S� PERMIT/SERVICES <br /> PHONE__ o .T FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE 3 Junes. Qp2 TIME <br /> (Please give 7 to 10 busine s days from da f apph, n su+,) YS al) 1�10 <br /> CHECK BOX TO EXPEDITE REQU T-$87.00 CARV! TS PROCESSED 1N 1 BUSIN'As g O <br /> SIGNATURE OF APPLICANT DATE O <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> a <br /> 00 r� <br /> 'D 1 <br /> ram <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILIT-Y ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOO/BODY PEIRCING ❑ POOL/SPA - - ❑ LAND USE APPLICATION SITES <br /> -MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 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 /> 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 fora 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 /> application may be submitted when the file is available. <br /> 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 /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed the next business day. <br /> DNFIRMED APPOINTMENT'DATE TIME ^ I <br /> \TE CONFIRMED <br /> PHONE FAX INITIALS <br />