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��-- �0 a <br /> to ID LOC NUMUEH <br /> DA C P.ECEIveu <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKI.ON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT —�V_ < BUSINESSIAGENCY - ��FT��-�— "— <br /> PHONE , FACSIMILE � <br /> TENTATIVE"APPOINTMENT DATE_- <br /> L Cj ']2Q ,6._Itr kV,,DhjTIME �� <br /> {Please glVe T to 10 husineu day&from dat4 of application submittal) <br /> CHECK ROX TO EXPkDITE REQUEST-$70.00 FFE�--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 316NA�611E OF APPLICANT DATE ^' <br /> riLE ADDRESS <br /> C <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SfTE(LOP) ❑ HOUSING ABATEnAENT ❑ 900D WASTE FACILITY <br /> if- THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY d SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL CI DAIRY <br /> i HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY In MOTELIHOTEL ❑ PUMPER TRUCKIYARC ICHEM TOILETS <br /> ❑ TATTOO18ODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selectod. Fax t ,(20991 46 0138 or mail to thq <br /> address indic2lt[�tl above. <br /> 2. EHL)will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ton(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be schoduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available far review. A now <br /> application may be submitted when the fibs is availabte. staff at <br /> 4- Any file not returned in the same condition as released will aillrbereorganized ra$T y EHD <br /> deposit priest x review. <br /> of the applicant. Future file reviews by the same app <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> fi, Applications received after 3:0a pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO _ REVIEW DATE, <br /> eN ao-ii alloloo - - <br /> 20'd GS:�T 09-LT-bQ 96fiZ-6LZ-646 <br />