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AMERICAN GEOLOGICAL 209 532 3809 OS/15103 09:50pm P. 002 <br /> U:J/1J/L4UJ 1'J.:JD GUJ400J4'� rar in rLUUR rHUt tlL <br /> SAN JOAQUIN COUNTY <br /> E010ONMENTAL HEALTH DEPARTMEN7-✓ <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT &k,^ BUSINESSIAGENCY��L�S <br /> ADDRESS I If 19 41Moog) U)eka <br /> Op p C ek <br /> PHONE FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of appaeation StAWRtal) <br /> CHECK BOX TO EXPEDITE REQUEST- 0 EEE—REQU STTP_OCUSEDDIN3BUSINESSDAYS <br /> X SIGNATURE OF APPLICANT ----' �JC��t 4 / DATE 151103 <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM <br /> -214�1 q 6 It ELEMrzTS SEARCH <br /> �e.v,. <br /> LJR a er 't lob <br /> a ar r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Cl UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT Q SOLID WASTE FACILfTY <br /> ❑ OTHER CLEANUP SrTE(NON-LOP) ❑ FOOD FACILITY O SOLA)WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH E3 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 13MOT"OTEL In PUMPER TRUCKA'ARDICHEMTOlLETS <br /> * MEDICALTATTOOIWASODY E F CIN" ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the We(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464.0138 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 saute applicant may require a$89.00 deposit prior to revleW. <br /> 5. *TI=NTATIVE appointment dates must be confirmed with EHb staff. <br /> 5. Applications received after 3:00 pm will ba processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME, .. - <br /> DATE CONFIRMED- PHONE. : FAX INITIALS <br /> REVIEWED XESNO REVIEW DATE <br /> a+xaa <br /> arsvl�m . <br />