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•� w\'{. Ni1lJN I�IJI�F�I� <br /> SAN J6AQU1N COUNTYPUBLIC HEALTH SERVICES Cjj 3 <br /> -F-WRONMENTAL HEALTH DIVISION <br /> i 304 EAST WEBER AVENUE,THIRD FLOOR <br /> s STOCKTON CA 95202 <br /> s (z09)4683420 <br /> PUS.LJC RECORDS RELEASE APPLICATION <br /> APPLI A?JT y) '�`Y�ItSp\1u{^ $USipNESSIAGEAlCY ��Af'Y'C�d•sast^ <br /> IQ —f-i <br /> PKON� - 1 of da 1 FACSIMiL P - <br /> . TENTATIVE'APPQ7NTMJ;XJT DATL" _ TIME <br /> (PSCG:C Q.7>a'l0 Lainezo day,from date of applieallon su fritial) <br /> 3j z/ <br /> AkCK 13,0XT0 L-X?$GIME REQUEST-397.00 FEE-REQUEST PROCESSED 10 3 BUSINESS GAYS <br /> SIGNiTURE OF APPLICANT .t _ ��r�rl���_ DATE � •��/d� <br /> " 1 T <br /> FIL1a AabgEss THIS SIDE VHP STAFF.USE ONLY <br /> j PRIPGRABR ELEMENTS SEARCH <br /> 4� C) vs a SD <br /> L <br /> 3 <br /> 3S 4 .1 <br /> ol, rti ag• n�.i <br /> `+ r <br /> r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> H H(LGROUND TANK(UST)CL9AN1J1s'SITE(LGP) O HOU$1NG ABATEMENT' Q 30LJ0 WASTE FACILITY <br /> ECtF_ANUP 517E(NOH-LOP) 15 FOOD FA.CJLJTY o SOLID WASTEVEHIC" <br /> ���,rUlI r:tGROUNO TAt4K(Moly TORINGMEMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> TiI ti DDUSWASTE OENERATOR ❑ CHICKEN RANCH ❑ PKC TRF.A7MENTPLgN1T <br /> 4(TIE PERMED EACJLITY o MOTEUN07EL 13 PUMPER TAUCKNARWCHW <br /> OILE'tS <br /> C3 TA cmODYPEIRCING © F4oUSPA D LAND USEAPP60AI(IONSITE9 <br /> MME GASTE <br /> FACJUTY ` ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE$PECIFYABOV$) <br /> 't. List Up tto,ten addresses'in the space above, Select the type(s)of files from the list above by chccking <br /> the appropriate box(es):-At Ieast o;It;file type MUST be selected. Fax to(2091 464-Qf38 or mail to trip' <br /> address indicl(ed above. <br /> 2. ! tzlila will notify the applibant if any EH❑files exist. An appointment for review will be confirmed <br /> approximately five busiricas days but no later than len(10) days after receipt of application,-The files <br /> will be held for a maximum of five business days for review. Appoirltmonts should be scheduled <br /> accordingly. <br /> 3. A file that is activcly bcin$workoct an by EHD staff may not be immediately available for review. A new <br /> uppUeattan maX bo subriaiticd when the filo is available. <br /> 4. Any filo not returned in the some e0nditiol't as rcicastd will be reorganized by EHD staff at Uic expense <br /> of theapplicant. Fi,4re;file reviews by the same applicant may require a 507400 deposit prior to revlgW, <br /> 5. 'TENTATIVE appcintmeiL datos must be confirmed with EHP staff. <br /> 6. Applications received after 3:00 pm will be procassed the next business day. <br /> i <br /> CONf11RtME0 APPOINTM tCrDATE TIME <br /> DATE)CFJNFIRMED _ PHONE F'AX' INITIALS <br /> REYlFv.gcD YES NO REVIEW DATE <br /> r oo 11 0 7ma <br /> Trtt'ot o a t <br /> 71-),A toil:)T l nn7 C z:1i nhi-AA - hjn-14x_p I <br />