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SARI JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 9 1 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR Y <br /> ST0CKT0N CA 952[)2 <br /> (209) 46e-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_0(�\6,P Hu$iNESS1AGEtNGY ,g„y� , { inc4� A_,e.0G,j Ac <br /> ADr3Ress Lod, elf `7 c olq O ^i <br /> PHONE Zort FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE� ��.� �_ TIME <br /> (Plonse give 7 to 14 b incss days from date of application submittal) <br /> CHECK BOX TO EXPI"Al IEQU g�Y-$8,7 OQ SEE—REQUEST PROCESSED(!3 0 BUSINESS <br /> DAYS <br /> SIGNATURE OF APPLICANT 0 _ DATE f <br /> . t <br /> FILE ADDRESS THIS SIDE EHD STAN USE ONLY <br /> PROGRAM EL✓.MENTS SEARCH <br /> 01. <br /> �v�� t YcRt ��litriTZS d` BCS 1�n 04 HiQ wo <br /> Z i r. wcli c- l�c>IGtt' <br /> ENVIRONIAHNITAL HEALTH DIVISION FILES <br /> O UfIDERGROUND TANK(US'r}CLEANUP SRE(LOP) 0 HOUSING ABATEMENT O SCUD wA3TE FACILITY <br /> 0 OTHER CLEANUP SITE(MON-LOP) ❑ FOOD I:ACILrff ❑ SOLID WASTE VEHICLE <br /> ❑ <br /> UNDERGROUND TANK(MONrrGRI Ndt eM0VAL) ❑ DOG MNHEL O DAIRY <br /> CI HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH O PK%TRBATMCKTPLANT <br /> 0 TIRED PERMITTED FACILITY ❑ 1110TELRiOTEL O PUMPER TRUCWYARDUCHEMTOILETS <br /> 0 TATFOO[BQDY PEIRC NG ❑ POOLlSPA Q LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY PUBLIC WATER SYSTEMA EFt{PLEASE SP�GIFY ASpVE} <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type DUST be selected. F (2Q91-494-4136 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 be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application.-The fries <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> :3. A fila 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;n the same Condition as released will be reorganized by EHD staff at the expanse <br /> of the applicant Future file reviews by the same-Applicant may require a$87.CID deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Ei. Applications received after 3;00 pm will be processed the next business day. <br /> 1 <br /> I , <br /> CONFIRMED APPOINTMENT DATE _ �,_ TIME <br /> ;DATE CONFIRMED PHONE FAX INITIALS <br /> i • <br /> , !REVIEWED YES NO REVIEW DATE <br /> t4 H1,171M <br /> 1%1 ' d 8696 '0h! .3mv q u0slapuy ',7 1 !@N NdLt:Zl loot" <br />