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d3-36-2e1 14J=37 iM FW* e o.a uuwocu <br /> oa r�auctivu <br /> SAN JOAQtCOUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468=3420 <br /> y� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1`�'1tC'�ZIC.� BUSIN"SIAGENCY Ari A-rroc✓aLcu�, Z c. <br /> ADARESS�} '' 11 <br /> PHONE�3�� 9LA -•�[�—FACsmLE CT ' 41 3 <br /> 7ENTATNE"gPP91NTGATE <br /> / �a TIM£ LISr//ddh <br /> (Pleaseje&%4 ova 7 1*10 p Hass days from data of appticatlan sybmlttal) <br /> CHECK BOX TO EXPEDITE REQUEST- E- UES PgQrA=ED IN]BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT _-. <br /> --THIS 510E END STAFF USE ONLY <br /> FILS ADDRESS <br /> . pRQGRAM ELEMENTS SEARCH <br /> rf4�O c�i f z o�/�Laa 35 18 (-f <br /> O��/1/C1✓ Oh J, oG/r)5�9 <br /> 3 7/ rs�an DAGl J�oc a`ca <br /> ENVIRONMeNTAL HEALTH DPASION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE.¢OP) M HOU5ING.ARAT'EMENT SOLID WASTE FAGLtTY <br /> M(OTHER CLEANUP SITE(NON-LOP) t7 FOOD FACILITY ❑ SOUDWASTEMICLE <br /> 1X UNDERGROUND TANK(MONITORINGIREMOVAL) E3 DOG KENN'd- ❑ DAIRY <br /> '0(HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> M TIERED PERHItrrED FACILITY m MoTELrHamL Q PUMPER TRUCKIYAPDICHENITOILDTS <br /> ❑ TA71700000Y PEIRCING ❑ POOIJSPA ❑ LAND USE APPLICATION SrMS <br /> ❑ MEDICAL WASTE FACILITY ❑ PUSUC WATER SYSTEM ❑ OTHER IPLEASF SPECIFY AUOVE) <br /> �. List up to ten address" in the space above. Select the types) of filen from the list above by checking <br /> the appropriate box(*$). At least one file type MUST be selected. Fax tv (20g) 464-U1,3$or mall to the <br /> gd Pts indicated a ve <br /> 2. EHD will.notlfy the applicant if any EHD files exist. An appoini>tlent 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. dv, <br /> 3. A fife that is actively being worked on by END s(afr may not be immediately available for review. A new <br /> application may be submitted when the file is ditariable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicantFuture file reviews by ttie zarii4�ppilcant may require a$87.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be Wnfl'. with F.HD staff. <br /> 6. Applications received after 3:00 pm will be prp6ysad the next business day. <br /> CONFIRMED APPOINTMENT DATE 70dB <br /> DACE CONFIRMED Pl O&E FAX INITIALS <br /> 1 , <br /> REVIEWED YES NO }.REVIEW DATE <br /> WSW w sawrroo TDTFL P.01 <br />