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SAN JOAQUIN C UNTYHUBUC HEALTH SEIRVICES <br /> VIRONMENTAL HEALTH DIMIC t � <br /> e04 EAST WEBER AVENUE, THIRD FLOOK -RUS —f {— <br /> STOCKTON CA 95202 <br /> ® L' (209) 468-3420 <br /> PUBLIIC� RECORDS RELEA�SEJ APPLICATION <br /> APPLICANTS BUSINESS/AGENCY [�[YIUC(1•I�C1Pn� rYQ �iu/ rK <br /> , <br /> ADDRESS L10695' Q C l- /7 saVS` <br /> / 7 We 1 - /J � <br /> PHONE �C) J FACSIMILE O( <br /> / i �7 O C <br /> TENTATIVE* APPOINTMENT DATE ` 4.md--.._,— TIME 1jr '•' `•' - AW � z 'n <br /> (Please give 7 lQ 70 b sines Mays from dale of application submitral) Cn m w <br /> M z <br /> CHECK BOX TO EXPEDITE REQU T - 378.00 FEE - REQUE T RO ESSED IN 3 DUUSINESS DAYS —h 2 <br /> SIGNATURE OF APPLICANT 4 DATE l0 FRi <br /> `^ 1 FILE A RESS <br /> 1 1 l Sc <br /> sc ! <br /> XC <br /> S p <br /> 30 <br /> ' � �� lSpra no CI es tetvt oyr 118 RD <br /> A, Ro ♦ fu s SU to <br /> ENVIRONMENTAL HEALTH <br /> r <br /> DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ED HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP} ❑ FOOD FACILITY 171 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORINWREMOVA)_) 0 DOG KENNEL El DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY L] MOTEL/HOTEL ❑ PUMPER TRUCKlYAR/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRGING Q POOLISPA 13 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 1.740THERSPL11ASE SPECIFY ABO <br /> 1 . List up to ten addresses In the space above. Select the type(s) of files from the list 4bove by checking <br /> the appropriate box(es) , At least one file type MUST be selected. Fax to {209} 464 D1 38 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 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 five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END 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 same applicant may require a $76. 00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must be confirmed with EHD 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 FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 0 1i 'PIRRQ <br />