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J. G hl�1-ivEa . I � % lv <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH S "RVICES <br /> ENVIRONMENTAL HEALTH DIVISIONt <br /> 304 EAST WEBERAVENUE, THIRD FLOOR oJ � <br /> STOCKTON CA 95202 <br /> (209) 468'-3420 <br /> PUBLIC RECORDS RELEAS/E� APPLICATION <br /> APPLICANT C O J r 6USINkMAGE ICY W R 1 � k K .1 o Cr {--� <br /> AODREss 3 0 Sb T UiA /,�-Q Rquif ucC! , Wr.- j j C r 9 l` 441 <br /> PHONE 9 — 3 14 FACS1MILE0 6_s <br /> TENTATIVE" APPpINTMENT DATE TIME <br /> please give T to 10 uvibuslnesaays from date or applfoagon submittal)rs 14 <br /> CHECK BOX TO EXPEDITE REQUEST - U7.00 FEE - REQU V PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE g <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS.SEARCH <br /> o n „ - llue- T7g Cv <br /> D V V G <br /> 0 [ N 4 — I r <br /> D L — W <br /> o hj <br /> Sick 3 <br /> fvl q r 4P oc <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDEROROUND TANK (USTI CLEANUP SITE (LOP) ❑ HOUSINGABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NOWLOP) ❑ FOOD FACILITY 13 SOLIDWASTE VEHICLE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL Q DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELDIOTEL M PUMPER TRUCVJYARDICHEM TOILETS <br /> O TATrOOIBODY Pt:iRCim ❑ POOIJSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O OTHER VPI FA SPECIFY ABOVE) <br /> 1 . List up to ten addrksses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate boY(esj. At least one file type MUST be selected. Fax to (209) 464-40138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the appllrant If any EHD flies exist. An appointment for review will he 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 flue business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3, A file that is actively being worked on by EHD slaff 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 same applicant may require a $67.00 deposit prior to review. <br /> 6. 'TENTATIVE appointment dates must be confirmed with EHO staff. • <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAA INITIALS <br /> REVIEWED YES NQ REVIEW DATE <br /> Mao to a !aa <br /> TOTAL P • 01 <br />