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SAiN JOAQUIN COUNTYPUBLIC HEALTH SFRVICES�✓ i 09 <br /> �.� WIRONMENTAL HEALTH DIVISIf <br /> A4 EAST WEBER AVENUE, THIRD FLOOk. <br /> STOCKI"ON CA 95202 <br /> (209) 408-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIO <br /> APPLCANT5 h ESS/AGENCY adOOM O&U <br /> ADDRESS (/OD f/��/h( Lo C a C . cF1 T <br /> PHONE n�) (� /D(/fP FACSIMILE � �J/ 1// 1 <br /> • <br /> TENTATIVE"APPOINTMENT DA I E TIME <br /> {Picas.give 7 to 10 Izusiness days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQU T-578.00 FEE—REQU 5 PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF=APPLICAN DATE <br /> FILE ADDRESS <br /> � I <br /> .7 1 �_ V✓0/l� <br /> eyoo <br /> !U I N`' <br /> Y1° g` <br /> IM" 13 S <br /> 37 5 L0; Lv� <br /> No rJly <br /> ! <br /> rico <br /> VSO 1 krd• ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) G HOUSING ABATa=MLNT O SOLID WASTE FACILITY O <br /> OTHER CLEANUP SITE(NOWLOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE 0 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH D PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHpTI--I_ O PUMPER TRUCKJYARD/CHEM TOILETS <br /> ❑ TATTOO140DY PEIRGING Q POOLlSPA ❑ LAND USE APPLICATION SITES �. <br /> * MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM p OTHER(PLEASE SPECIFY ABOVE) (� <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 MUST be selected. Fax to (209) 464-0138 or mail.to the <br /> address indlCated 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 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 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 some 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 $78.00 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 /> CONFIRISIIEI� APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01105100 <br /> of q12 I q , 00 cpm <br />