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i <br /> FROMLHGe gqir e� .. FAX N0. : 2095690295 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES �UG 0 1 2002 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WE13ER AVENUE, THIRD FLOOR ENVIRONMENT HEALTH <br /> STOCKTON CA 95202 PER VI S <br /> (209) 468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> 51J�/ �� BUSINESSIAGENCY 4h- Q�-�r �`�Wd n irlP rQ� <br /> ADDRESS 7M <br /> G— r <br /> PHONEJJ� 6FACSIMILE <br /> SIMILE , <br /> TENTATIVE' APPOINTMENT DATE TIME <br /> (Ploasa glv6 T l014 bqslivas' ays tumn dIap pile on submittal) <br /> rN <br /> CHECK BOX TO EXPEDITE REQUEST . $89.00 EE— REQUEST PROCESSED IN S B INE DAYS ' <br /> SIGNATURE OF APPLICANT DATE�_ <br /> FILEJill <br /> ADDRESS iHis SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH - <br /> rj0 f 'v � da. ee V/4 1 '0"M <br /> / r �✓ 1y � . <br /> All <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT ElSOLID WASTE FACILITY <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) III FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE (NON•LOP) O DOG KENNEL O DAIRY _ <br /> UNDERGROUND TANK (MONI7oRINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL O PUMPER TRUCKIYAROICHEM TOILETS <br /> o TIERED PERMITTED FACILnYp POOUSPA ❑ LAND USE APPLICATION SITES <br /> O TATTOOIBODY PEIRCING p pUDUG WATER SYSTEM O OTHER (PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY 5 <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 (2091 404 0138 or mail to the <br /> addresS indicated above. <br /> 2, EHD will notify the app)icant if any EHD files exist An appointment for review will of application. The files <br /> approximatelyfive business days but no later than ten ( 0) days after recei onfirmed <br /> t <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3, A Lite that .is actively being worked on by EHD staff may not be ) mmediatoly available for review., A new , <br /> application may bo submitted when the file is available. <br /> 4. Any file not returned if' 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 $39.00 deposit prior to review. <br /> 5, 'TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> 0, Applications received after 3:00 pm will bo processed the next business day. <br /> CONFIRMED APPOINTMENT DATE., TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> YES ._ .-_.. NO REVIEW DATE= — <br /> .nninnr . <br /> I „ <br />