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P <br /> ` :55uFAX 925499 REEK W-4Auu <br /> 485 WESTON WALNUT C 0002 <br /> ENVIR ALTH PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES setocNe� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> � 304 EAST WEBER AVENUE,THIRD FLOOR j <br /> STOCKTON CA 95202 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATIONra <br /> APPLICANT_ j� Pk�A•)IA�( BUSINESSIAGENCY_ %eJd n2ti, 6o�1xTlowkk �ie.�•,j_„___� <br /> ADDRESS 1'0 TfL J CL-Up.i V•lALwluT— C- u '6 �QQ� <br /> k g <br /> PHONE ?� -•r-(,7iU <br /> _ <br /> _ FAasrtnt>E^(R2s� 2475:— e048 sNMi{N�T�HF�4'TI i <br /> FD 1j+�+ ` D�ENTOATE ��V1Cf <br /> \"J TWE _ <br /> ,�,t n�((�I ase aive 7 to 10 busl�rys�d•Ate gZJpppllca�p��/rysutrnlml) <br /> CHECK VUA EZi 61.1ESr- .�E-REQUEST PROCEfSED AU3 eSS DAYS •`.1, <br /> SIGNATMf� Mdyl tTH DATE ��Za�r •S"r3De] <br /> 2PRMIPSERVICES <br /> A+� <br /> FILE ADDRESS THIS SIDE EHD STAFF USRDKY' <br /> PROGRAM ELEMENTS SEM <br /> J/ ENVIRONMENTAL HEALTH DIVISION FILEESS/ :t <br /> �(1NDERGROUND TANK(U:�CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 1� SOUD WASTE FACILITY, <br /> ®®WF THER CLEANUP SIIR(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICL <br /> 3yNDERGROUND TANK(NONMOR1NGIREMOVAL) ❑ DOG KENNEL '0 DAIRY <br /> u7,,NNA7ARDOUS WASTE GENERATOR t7 CHICKEN RANCH O PKG TREATMENT PLA*' <br /> 6?'T1ERE0PERMr9TFACULTY O MOTEUHOTEL ❑ PUMPER TRUCKIYAPAWAEM TOILETS <br /> Q TATTOOMOOY PEIRCNG rl POOLISPA O LAND USE APPUCATftW StrrS <br /> U M01CAL WASTE FACILfrf O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPIf6pY ABOVE) <br /> 1. List up to tan addresses in the space above. Select the type(s) of files from the list aho' a by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)404-W38' mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointmant for review will be dd(flrmed <br /> approximately five business days but no later than ten (10) days after receipt of applicatTen. The files <br /> will be held for a maximum of five business days for review. Appointments should be 96heduled <br /> accordingly. -*,iT. <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately available tbr'.rovlew. A new <br /> application may be submittod.when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD sfaff•at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review, <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> E. Applications received after 3:00 pm will bo processed the next business day. <br /> -1. <br /> CONFIRMED APPOINTMENT DATE. TIME a <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />