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** T0'39Ud -1U101 ** <br /> G.,. —, —& —Uc »O`+U. CNV IKUNMtN I HL r H PAGE 01 <br /> LLYC <br /> vM141u <br /> SAN;JOAQUIN COUNTYPUBLIC HEALTH SERVICES Li I.•.,., <br /> (ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> /� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT(r C Cl I Irl�t�Gi'^ BUSINESSIAGENCY 31 <br /> ADDRESS 7 / �/aPll�t�P✓JJvY - � .ALJ �CL,c�Ltnrl �14 2�COb / <br /> PHON —`7` D FACSIMILE O— <br /> E <br /> TENTATIVE'APPOINTMENT DATE f1.CO IBJ TIME 1 a <br /> (Please give T t 10 busi ss m da o^ ppllem;on submittal) ` <br /> 13 CHECK BOX TO EXPEDITE R>= EST.Sg9, QUE t PROI:Es IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE L <br /> FILE ADDRESS THIS 5113E EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> L02 77 Wl a ncl TI, Lo-Mrooa c,o <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT CI SOLID WASTE FACILITY <br /> OTHER CLEANUP SrrE(NON-LDP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 17 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR D CHICKEN RANCH C3 PKG TRI=ATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ' 0 PUMPER TRUCK/YARDICKEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING 0 POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL wASTB FACILITY ❑ PUBLIC WATER SYSTEM O 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 selected. Fax to (209)464.0138 or mail to the <br /> address indicated above. <br /> 2. EHD 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 ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same cond[Uon as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89,00 deposit prior to review. <br /> S. `TENTATIVE appolntmant dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME. <br /> DATE CONFIRMED PHONE FAX INfT]ALS <br /> REVIEWED YES NO REVIEW DATE _ <br /> �e•o�aoe <br /> oc.nacn•�.n.n. <br /> TO/TO'd 82T0b9b60ET 01 dd 60:60 EOOE 80 NJU <br />