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` 10- U 0DO ©? : Y'Pt•I FR w . . , . ._ , cTO i415453Sh61 P . f)2 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES �,. rueLLtN <br /> v ENVIRONMENTAL HEALTH DIVISION O� <br /> " 304 EAST WEBER AVENUE, TP IRD FLOOR <br /> STOCKTON CA 952C2 <br /> (2D9) 468-342D <br /> PUBLIC RECORDS RELEASE. APPLICATION <br /> < Y,R!tgIT1 _ (�.yLG _, /I •S DUSIN,E/}SS/I�AG�ENG�Y,, �J 1 /� {�//�I//�)�lI - <br /> IDRE55 - ,_ ._[ [- i�l� � r,4{ xo L A <br /> PHONE J SO FACSIMILE <br /> � I <br /> TENTATIVE' APPOINTMENT DATE It � 3 ) TINC T - 1 `� Y 11iiIv <br /> (Please give 7 in 10 business days from date o7 appflcalion subminni) <br /> CHECK Box TQ EXPEDITE REQUEST • S87. oFEE -7FtEQQ 'ST R CESSED '- N � BUSINESSDAYS <br /> SIGNATURE OF APPLICANT Gf/��^ �/) DATE <br /> FILE ADDRESS THISSIDEEHD sTAFFUSEONLY <br /> i PROGRAM ELEMENTS SEARCH - <br /> �. <br /> t? j5 ..r4 4 <br /> ilk, <br /> ENVIRONMENTAL HEALTH DIVISION FRES <br /> UNDERGROUND TANK (USTI CLEANUP SITE (LOP) D HOUSING ABA7EMENY El SOLID WASTE FAOILnY �n d <br /> ❑ OTHER CLEANUP SITE iNONLDPJ FOOD FACILITY ❑ SOLID WASTE VEHICLE ` J � (�� �'1�-V�/�- <br /> ❑ UNDERGROUND TANK (MON(TORINGIREMOVAL) O DOG KENNEL - n DAIRY � J <br /> O HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT-PUNT 'V <br /> 4 TIERED PFRNITTCD FACILITY 6 MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHFMTOILETS <br /> * TATTOOIEDDY PEIRCJNG D POORSPA - D LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 17 PUBLIC WATER 5YSTE 4 ❑ OTHER (PLFA$E SPECIFY ABOVE) <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 1209) 464.0138 or mail to the <br /> addr@35 indicated above. <br /> 2. L- HD will notify the applicant if any EHD files exist An appointment for review will he confirmed <br /> approximately five business days but n0 later than len ( 10) days after receipt of application. The files <br /> will be held for a maximum of five business days for revie•N. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is aclively being worked on by EHD staff may n<:t be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4 . Any file not returned in the barn condition as released will be reergahized by EHO 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 with EHO staff. <br /> 60 Applications received after 3:00 pm will be processed the kicxt business day- <br /> CONFIRMED APPOINTMENT DATE _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> { REVIEWED YES NO - _ REVIEW DATE <br /> i� peNilee <br /> TOTAL P . 02 <br />