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FI0 LUG NUMBER,' park AG;EvE0 SAM JOAQUIN CiOUNTYPU13LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,THIRD FLOOR STOCKTON CA 95202 (209) 468-3420 �j PUBLIC RECORDS RELEASE APPLICATION svc3lNEssrAsNCY APPLICANT GE CAt� /� ADDRESS PHONE '+t a } � ESQ j --FACSIMILE -'''� K T 1�Lt c�n9cD Air ` Qt7 cy.,.+ TE'4TATIVE*APPOiNTMENT DATE TIME (Please give 7 to IU businessrjAys from date of aPPIM3tiae submittal) CHECK BOX TO EXPEDITE RECIUE.S - FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS DATE SIGNATURE OF APPLICANT C CJ F L-ADDRESS � L� l U ►�a.h-fit 1 n�- u k i3 h1�cx'►� a �'t ez-t ilk9 6 V G A tV C[�Y+11 P tJ u I�T Cs� C Pt C �- g�'z 4La V� ENVIRONMENTAL HEALTH DIVISION FILES IE3HOUSING ABATEMENT ❑ SOLID WASTE FACILITY ❑ NDERGRC UN TANK(UST)Ct_FAPiUP SITE(LOP} ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE CHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY Q UNDERGRC UND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT L1 }{p2ARDOL'S WAST7=GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS ❑ TIERED PERMITTED FACILITY p FOOLI8PA ❑ LAND USE APPLICATION SITES ❑ TATTQOBCIDY PEIRCING ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY AUQVE) C MEDICAL WASTE FACILITY 1_ Li:;t up to ten addresses in the space above. Select the type($)of files from the list above by checking thn appropriate boxes). At least one file type MUST be selected. Fax to X2091 d 4-0138 or cif to the addres indicated above. ny IrHD Tilos exist. An appointment for review will be confirmed 2. EF,D will notify the applicant if a approximately five business days but no later than ten(10) days after receipt of application. The files wi I be hol(l for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A-11e that is actively being worked on by EHO staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any f le not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future fife ravlews by the same applicant may require a $78.00 deposit prior to review. 5. tT�NTATIVE appointment dates must be confirmed with EHD staff. g. A ,plication$ received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME • DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE -J ::rt CO 14 ottasr+a 9�:T(3 ICJ 00:-_T6SO=C�i;