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444q <br /> ti <br /> s � <br /> ''::U4YC%t4CN[A CNOL(IIi NLMIFX <br /> SAN JOAQUIN COUNTYPUSLIC HEALTH SERVICES <br /> ENVIRONMENMAL.HEALTH DfV �ISION `✓ ppp� Y,��� <br /> 304 EAST WEBER AVENE7E�Tf1lRD FLOOR <br /> STOCKTON CA 95242 <br /> (203)468.3420 p <br /> PUBLIC RECORDS RELEASE APPLICATION `'J 2� <br /> APPUCANT ��t r ry SUSINESSIAGENCY 1(JtS <br /> ADDRESS 11 ktW.. WAvo gj[ r f,-44eU; CA2 ry <br /> PHONE -10189iS FAt;sPXLB n32 - <br /> TENTATIVE'APPOINAiFhT DATED»Ik-F TIME <br /> (pio *sieo 7 to 10bulnaaa aq•a from da teoffapplication suSmlttaf) <br /> CHECKE=TOEXP CITEREQU65T- SE-RE PROCE05E0 IN 3AU61 YS <br /> SIGNATURE OF APPLICANT DATE _iDAf/M <br /> FILL AODRE33 TNSS SIDE FMO8TA"USE ONLY <br /> Afro R <br /> ..++�� PROOR/VHELEMEMTS 68ARCH <br /> 1 <br /> 4 <br /> 504 <br /> w 9•t;o i <br /> i <br /> 9,t o <br /> ENV(RONMEh7AL HEALTH DIVISION FILES <br /> /UNDCRGROUND TANK(UT.9 CLEANUP aiiY(I-Ce] ❑ HOUSINZ AaATEMENT ❑ SOLID WASTE FACILITY <br /> WHER CLEANUP 31TE[NON-LOP) ❑ FOOD FACILITY E3 SOLID WAWM VEHIOL6 <br /> `012RGROUND:ANK(rAONtTORrNC4R9MOVAL) G COG KENNEL D DAIRY <br /> U HAZARDOUS WASTE GEWRATOR 6 CHICKEN RANCR D PK3 TRERTAMW PLANT <br /> D TIERED PE(RNRTED FACILITY n btOT2Lni0TEL E3 PUMPER TKOCK1YARDACKEN TOILETS <br /> D TATTOOMODYMIRCINZ ❑ POOL5PA 17 LAND USE APPUCAT`ON SITES <br /> J MEDICALWASTEFACIUTY fn PVULIC WATER SYSTEMA Cl OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addre49e4 in the space above. Select the type(z)of Blas from the Ust above by checKing <br /> the appropriate box(eG). Al least one File type MUST be selected. Fax to(298)464.013a or mail to the <br /> addreZ5 indlimteaMa <br /> 2. EHD will notify the applicant if any EHD 1004 exist. An appointment for review w1H be confirmed <br /> approximately five business days but no laterthan ten(10) days after rormiptOf application. The files <br /> will be held for a maximum of five busino"days for review, Appointments should ba zchaduled <br /> accordingly. <br /> 3. A file that Is actively being wonted on by EHD staff may not be immediately available for review_ A new <br /> application may be submitted when the file fa available, ' <br /> 4. Any file not returned in the came condition ao released will be reorganized by EHD staff at the axponse <br /> of the applicant. Future file reviews by the lama applicant may require a 67E.00 deposit prior to review. <br /> ! 'TENTATIVE appointment dates must ba confirmed with ISHO staff, <br /> 0.[CONFIRMED <br /> mce1VW 2her 3:00 pm will be processed the next buaint:sa day. <br /> ft CONFI` RMED APPOI"AENT DATE T(ME <br /> f DATE CONFIRMED PHONE FAX HJtTWLS <br /> i REVIEWED YES NO REVIEW DATE _ <br /> en N t1 YJiNd <br /> TOT- P.W <br /> Td WdCc:SO OOOZ 70 '400 2886 82-8 601, : 'CN 3NCIHd sls6iE�U ouaZ puno.ird ; WOtld <br />