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DATE RECUVED <br /> L SAN JOAQUIN COUNTY FHQ t.00 N1)U1F.,R <br /> I <br /> f—NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 F&St Mail, Street, Stockton, CA 95202,3029 <br /> 2008 Telephone: (209) 4683420 Fax: (209)4.64-0130 Web, <br /> WWW_9 <br /> jg V. <br /> - H E i),LT H 71D <br /> P,.U'.8.L!C RECORDS RELEASE APPLICATION <br /> PIT— <br /> APPL;CANT; BUSINr-SS1AGE--Ncy- <br /> ADDRESS: <br /> PHONF=(I): PHONE�(2): PACSIMILE. <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Plou so allow ton business days from date or sop plicatioll submittal-+—rEnfwivv only-triam Eo—confirmoo) <br /> CHECK BOX TO EXPEDITE REQUEST-$98.00 rUE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN Tl*FE BU51NESS DAYS <br /> SIGNATURE OF APPLICANT L DATE <br /> Electronic Information., 0 List E]Map-Descriptio": <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> . ....... Street NZIFTIL City f7 <br /> t)"j. <br /> 2, 0 unit z: . . <br /> 4, <br /> 10. <br /> 5. <br /> 7. <br /> Unit 6 <br /> Specific Date Range of information Requested:From to <br /> , ENVIRONMENTAL HEALTH DEPARTMENT MLES <br /> A UNDCRGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOLKimr.AnArumcw' 0 SOLID WASTE VACILITYfVEI 11CLE <br /> 0 OTHER CLEANUP S1 rE(NON-LOP) 0 FOOD FACILITY ri vmSnr-Trrir <br /> 11 LINDARcRouNo TANK(MONITORINGIRSMOVAL) 0 DOG KENNEL Cl(?Ainy <br /> 0 HAZARDOUS VVAuTE:GENLRA70R 0 CHICKEN RANCH 0 WAr,%WAI(-,R TFZr.ATMr:NT PLANT <br /> 0 TtEnRED PERMI I TfD FACILITY 0 MWEL/Hom 0 PkjmprR TRUCIeJYARCIGOiLM TOILLTtl <br /> 0 TAT-Too/000y PIERCING 0 P00USPA El LAND UsE Awi ICATION SIlFS <br /> C3 MEDICAL WASTE FACILITY 1110 1110(P],VAAC SPECIFY) <br /> WELL AND S ErT;C PLAMI t RF.00Rr4 ARP AVAJLAULr rOR FZCVICW - 1111ONVAY-rRIDAY 0:%AM-5:00t%m - EXCLUDING 1-101,11)AYS, <br /> i. List tip to ton addresses in the 5P2CO above. Select tho typc(s)of files front tike list above by check?;ig the appropriate <br /> box(os). At least orie filo typo MUST bo selected. Fax to 209)464-013$or mall to 11henijove Adtfroqn. Address rong,s will <br /> not 130 accepted-for additional assistance with file addresses,contact the EHO. Applications received after 3.00 rim will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. Art appointment for revlaw will be confirmed approximately tell <br /> days after receipt of application. The files will be hold for 0 ITIOXIMLIm Of fiVIU bLlSi"OSs days for review. Appolntmc-!rlt:7, <br /> StIoLLId lie scheduled aCCOrdingly. <br /> 3. A file that is actively being worked on by the El-10 staff may not be immediately available for review. A now application <br /> may be submitted when the file Is available. <br /> 4. Any File not returned in tlio same condition as rclua5ed will be reorganized by EHD staff at the expense or the appiicant. <br /> Future file reyiews,by the same applicaril may require a$98.00 deposit prior to review. <br /> --EHD USE ONLY <br /> EK948-QG rdRk'' <br /> EO 'd ON XVj Wd vs!�l M Booz-11-Iff <br />