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SAN JOAQ.41N COUNTYPUBLIC HEALTK SER\".CES I <br /> EN' �ONMENTAL HEALTH DIVISION S 4 <br /> 304 EAST WEBER AVENUE.THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 209 465-3420 �O <br /> DS RELEASE APPLICATION_ <br /> PUBLIC RECORDS <br /> 5,PPLICANT Gr1Ss�y f F BUSINESS <br /> !AGENCY 1e- sSQU L -� <br /> aDDREss 1117 Lb,%jr_ P)4L-►v% <br /> Aug', utr . 13 IV►oD <br /> �` g --zzzr FACSIMILd ao9572 -- 2'2'2-5 0GI 0 4 ZOO <br /> HONE _ <br /> TENTATIVE" APPOINTMENT DATE TIME RJJJEALTH <br /> (Picav,c {live 7 to 7o buincss days rroi ate hlicatio ubmiltal) pERMIT/SEFiV10ES <br /> � qdlfs.T <br /> CHECK[iOx TO,C XPEDi7E REQUEST-$II7.00 FEPROC-55CU51 55 BAYS s <br /> SIGNATURE.OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE CHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> S o oN -30o rr� L - S'n&_716sJ <br /> Etu..lor �sr��••.�� — 9�F c� ° . <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) '0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTKER,CLEANUP SITE(NON-LOP) .0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) !0 DOG KENNEL 0 DAIRY <br /> 0 cHICKEN RANCI4 ❑ PKG TREATMENT PLANT. <br /> kO HAZARDOUS WASTE GENERATOR .,O MOTEL/HOTEL O PUMPER TRUCIVYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLISPA C3 LAND USE APPLICATION SITES <br /> 13 TATTOO!©ODY Pi�1RC1NG l°i a PUBLIC wATLR.5YS7L•M ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY Ij <br /> �. List up-to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be Selected. Fax to(209) 464-0138 or m;Iil Io the <br /> address indir.ated above. <br /> 2. EHD will notify the applicant if any EHO files exist. An appointment for review will be confirmed <br /> approxil-nately five business days but no later than ten (10) days after receipt of application.-The filv5 <br /> will be held for a maximum of five business days for review. Appointments should be.sclicdulCd <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 same applicant may require a $37.00 deposit prior to review. <br /> I 5. `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 /> FCCONFIRMED APPOINTMENT DATE TIME <br /> NFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE � <br /> til ao �� aara�raa .—. <br />