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FF1; NO. t.�9�E.90-95 "fay• E15 2000 10:48R1 Fc <br /> FRol.• - Geo,-sPhase .lrvr�mentdl ,. k„MLOG 14UMBEu <br /> 1rb •IV <br /> - SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES j •"�;arvi'a` <br /> ' ENVIRONMENTAL HEALTH DIVISION i•7; ,� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> fSTOCKTON CA 95202 <br /> (209)466-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> RUSLNfiSSIAGEPICY 7-q - <br /> APPLICANT �'T•w /o �CQMr _ t <br /> ADDRESS <br /> PHONE „o FACSIMILE <br /> _� MAY CUM <br /> TIME l� M <br /> T ATE s frorti date of application svIxnittni) <br /> ( give l to 14 business day �`�,;I,UI\I I•�I L,+I • ' EALT1 <br /> 'fir:=:- PEZMIT/SF.;<v ICES <br /> HECK BOX TO EXPEDITE REQUEST-$78-00 FEE REQUEST PROCE55LD 1N 3 BUS ESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> >-17.E ADDRESS <br /> O <br /> moo ,tI 0� <br /> i <br /> L - <br /> �, r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT in SOLID WASTE FACILITY <br /> y uM)ERGROUND TANK(UST)CLEAI.UP SITE(LOP) 0 FOOD FACILITY L7 SOLID WASTE VEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) p DOG KENNEL 13 DAIRY <br /> 0 UNDERGROUND TANK(MONfrORINGIREMOVAL) RANCH M YKG TREATMENT PLANT <br /> Q HAZARDOUS WASrt GENERATOR p CHICKEHOTEL ❑ PUMPER TRUCKYARDICHEMTO1LET5 <br /> 11 CHICKEN <br /> C TIERED PERMITTED FACILITY El p0OL1SPA [ OTHELANDR <br /> USE EASEAPpSPECIFY <br /> SITES <br /> ❑ TATToorBooY PELRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER{PLEASE SPECK ABOVE} <br /> p MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list abovo by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 46d 0138 or mail to the <br /> address indicated above. <br /> itAn appointment 8 ointment fol'review will be confirmed <br /> 2. EHD will notify thea licant if any EHD files exist. <br /> approximately five business days but no later than ten(10)days ointments show d be scheduled <br /> er receipt of appliGat-lon. The files <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> ly being worked on by EHD staff may not be immediately available for review. new <br /> 3, a file that is active <br /> application may be submitted when the file is available. expense <br /> 4_ Any file not returned in the same condition as released ld antma reorganized wiil be requia $78.0 deposit prior eto review,of the applicant. Future file reviews by the same app Y <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 day. <br /> [CONFIRMEDAPPOINTMENT DATE TIME <br /> DATE CONFiRMEQ <br /> PHONE FAX INITIALS <br /> R>nVIEWED YES NO REVIEW DATE <br /> en ua �+-airosroa <br />