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°r 1 <br /> JFROIR <br /> mental I- 1 FPX NQ. 2095690295 t` " ec. 29 2005 05:48PM P2 <br /> END BOG NUASB[k <br /> SAN iOAQUIN COUNTYPU13LIC HEALTH SERVICES <br /> 2005 ENVIRONMENTAL HEALTH DIVISION <br /> 344 EAST WEBER AVENUE,THIRD FLOOR <br /> {"F{ ,•,I;i n ES i STOCKTON CA 95202 <br /> (209)468-U20 <br /> �Sr: �fC�S <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 1�y k <br /> APPLJCANT BUSiNESS/AGENGY ��/�Qr.t� '7 ' <br /> ADDRESS <br /> PHONE FAdSIMILE d g <br /> TENTATJVE*•APPOINTN EN r DATr, <br /> TIME <br /> (Please glva 7 tD 10 btAinoss days from date of apPllcat on submittal) z <br /> CHICK BOX TO EXPEDITE REQUEST.$89.0a FEE-R>=4IJEST PROCESS N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DA`PE . <br /> FILE—ADDRESS TyIS SIDE END STAFF usE ONLY <br /> PROGRAM ELEMENTS SEA11CH <br /> it r+ <br /> -25 <br /> APO 16A <br /> k%k <br /> VIA <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(Lop) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> J�i�f#tElt CLEANl7P 5171:(NON-LAP) q FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> }p tJNt)I:RGROtIHD TAHK(MONiTORINGIREMOVAL) Q DOG KENNET_ 13 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑ PKG TREATMENT PLANT - <br /> 0 TIERED PERMITTED FACIUTY 13 t11OTELtHOTEL El PUMPER T'RUCKIYARAICHEM ToiLETS . <br /> 13 TATTOOISODY PEIRCING M POQUSPA 0 LAND USE APPLICATION SITES _ <br /> 17 MEDICAL WASTE FACILITY 17 PUaIJC WATER SYSTEM tO OTHER(PLEASE SPr=CIFY ABOVE) <br /> 1. List up to tan 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 46"138 or.mall to the <br /> address indicated above. <br /> 2. EHO will notify the applicant If any EHd files exist.IAn appointment for review will be confirmtcl <br /> approximately five buWness days but no tater than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for reviow. Appointments should be scheduled <br /> accordingly. <br /> 3.' A file that.is actively b�ing 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 fle not returned ill the same condition as released will be reorganized by EHI]staff at the expense <br /> of the applicant. Future file reviews by rho same applicant may require B$89.04 deposit prior to review. <br /> 5. *TENTATIVE appointment dates Dust be confirmed with EHD staff. <br /> ,6. Applications recelved after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> [SATE CONFIRMED PHONE FAX -INITIALS <br /> REVIEWED <br /> n�,-�"�— YES NO RirVll"W DATE <br />