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Mar-26-Q2 11 !21A P_02 <br /> NATQ RGGRIV[D EHD LOG equfftEP <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SEKv1CF$ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 FAST WESER AVENUE,THIOD FLOOR <br /> STOCKTON CA 95202 <br /> (209)458.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r I(1 SUSINESSiAGENCY <br /> ADDRESS W !v Q <br /> PHONE r �✓ i FAC31NdILP Q�� fP d o�• �c� <br /> TENTATIVE"APPOINTMENTOATE TIIJI��7 <br /> (Please glue T to to uGalrass dayc Fwm date Qf ep mon suhni 1) <br /> l <br /> SIGNATURE OF APPLICANT DATE 3' Z�~ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM=LEMENTS SEARCH <br /> .r. <br /> I- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEIAENT fl SOLID WARTS FACILITY <br /> 1~ OTHER CLEANUP SITE(NON-LOP) n FOOD rACILrrY C] 96Ltb WASTE VEYtGLE <br /> Q UNDERGROUND TANK(MONITOR i NG/RE MOVAL) ❑ DOG KENNEL DAIRY <br /> G HA'ZARD00 WASTE GENERATOR ❑ CHICKEN RANCH f_l PXG TREATMENT PLANT <br /> ❑ TIERED PERMI'T'TED FACILITY ❑ MOTELHOTEL ❑ PUMPER T RUCKlYARnfCHEM TOILETS <br /> 71 TATTOOIBODY PEIRCING ❑ POOLISPA 0 LAND U9E APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select tho type(s)of flies from 'he list aboVo t:y checking <br /> the appropriate boK(p5). At least ane file type MUST be selected. Fox to( 0i.464-0138 or mail to the <br /> addross Indic Atgdapove., <br /> 2. EHD will notify the applicant if any EHD files exist_ An appointment for review will bo confirmed <br /> approximately flva business days but no tater than ten (10)days after receipt of applieailon. 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 now <br /> application may be submitted when the file is available. <br /> 4. Any file not retumed 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 $89.00 deposit prior to review. <br /> 3. "TENTATIVE appointment dates must bo confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be proreaaed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> } REVIEWED YES NO REVIEW DATE <br /> 20001 SNIL14 HNNVZ11S V Dam 9ZC669C60ZT XYd LT:TT ZOOZ/9Z/CO <br />