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.A 4.1b Jbb 7013 KLEINFELDER 1;2 002 <br /> J9 9480621 SACFULME-U0 @1003 <br /> • ahv goo wu►+eea <br /> SAN JOAQUIN COUNTYPLIBLIC HEALTH SERVICEZ, <br /> ENVIRONMENTAL HEALTH DIVISION 130q <br /> 3o4 EAST WEBER AVENUE,THIRD FLOOR <br /> i STOCKTON CA 99202 <br /> (209)468,420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ,hr 65-k ala WL BUSINE:SWAGi:-NCY <br /> I"7,(.p x 32-0 FACS IMIJ�`N,? 0(co— 101 r:�, _ ----�— l <br /> TENTATIVE <br /> APPOINTML�iT DATEjaILGIA TIMET <br /> (Please ptve T to 10 bwUness days from dale ofaPP&MUOn submtq+il) <br /> T FEAT—REauf" P iOCESSED IN]BUSINESS DAYS • <br /> CHECK BOX TO EXPEDITE REQ S8 { <br /> ( f11/. ��J I DATE: "� 2 0 <br /> SIGNATURE OF APPLICANT <br /> FILE AD13RESS THIS SIDE 1:1-1 <br /> D S/T/T AFF USE ONLY <br /> PROGRAM ELEMPNTB SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUS(MG ABATEMENT SOLio WAS11�FACXM <br /> HIGLE <br /> OTHER CLEANUP SCFE(NON-LOP) D FOOD PA':ILM <br /> UNDERGROUNDTAHK(MONfTOR140JREMOVALI 0 DOG KENNELDAlIZY <br /> } ZARDOUS WASTE GENEItAT�R ❑ CHICKEN RANCH ❑JPKG;TFEATI RENT PLANT <br /> 7lEREDPE'RIV(iTTEbFAC1lJTY O MOTELIHVTEL ❑ PUNIPE:RTFI'JCKIYA�RDJCHEMTOILETS <br /> ❑ T 0DY PEIRCI 'PLAT 17 IIsE d PprocATION 3rM'S <br /> 13 MEDICAL WASTE FACILITY 0 PUBLICYrATER SYSTEM0 on,iP.(PUAS-^f'ECfFYAB'DV <br /> E.) <br /> 1. List up to ten addresses in the space above. kieiect the type(s) of files fFr)nl thil ll$t aheve by checking <br /> the appropriate box(es), At least one file type MUST be selected. FaX to L2291, QLLQi1 t <br /> address indicated above, <br /> 2. EHD will notify the applicant if any EHD files e.cist. An appointment for r�3view NiU be confirmed <br /> approximately five business days but no later than ton(10) days after re::e,ipt o'.application_ fhsr files <br /> will be held for a maximUm of five business days for review. Appointment, should be scheduled <br /> accordingly. <br /> 3. A file that is actively toeing worked on by EHD staff may not be (mmedial:rfly aw,llabie for ravle:w. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reor()anizr:d'by 1=HCI staff at th�i ea�pen:�e <br /> of the applicant- Future file reviews by the same applicant may require n f 87.03 djapuait prior to review, <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business d;iy. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX WITI AL S _ <br /> REVIEWED YES NO - REVIEW DATE <br /> 61 sou sae+oo <br />