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.lv V.�liILZo o. A1UUKL SAI. u u o L <br /> ,.1 �.� �._.�< ice, iI rIN iU 1y1b-3^l04UU.1. P.01 <br /> :RrcCrvEp CnauOG �c <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> EN'01RONMENTAL HEALTH DIVISION D <br /> J' O 3134 EAST WE13ER AVENUE,THIRD FLOOR <br /> U wl STOCKTON CA%202 <br /> n. (203)485.3420 SEP 19 <br /> PUBLIC RECORDS RELEASE APPLICATION 2000 <br /> NMENT HEALTH <br /> �PPLICAN7 f3US[NESSlAGENGY <br /> --tt D nnelT in-p. .._ <br /> A DDRESS M !h �L11. t(> a <br /> ?NONE V FACSIMILE <br /> I <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 businean days from data of application Submittal) <br /> CHECK BOX TO EXPEbITE REQUEST-SE7.00 FIE—RE S7 ROCESSED IN 3 SUSINLES DAYS n <br /> SIGNATURE OF APPLICANT DATE u} (�f <br /> I <br /> i <br /> FILE ADDRESS THIS SIPE E"P STAFF USE ONLY <br /> PROGRAM ELEMENTS 5EARCH <br /> EkJf <br /> �� <br /> pD 5 = <br /> PCM 14 TNP C11 <br /> 5 <br /> I <br /> I <br /> ENVIRONMEN4 HEALTH DIVISION FILE$ <br /> V UNDERGROUND TAKK(UST)CLEANUP SITE(LOP) ❑ HOU$03 ABATEMENT O SOLID WASTE FACILITY <br /> WOTHER cLfANUP srTE(NON-I-OP) ❑ FOOD FAGILrrY ❑ SOLIP WASTE VEHICLE, <br /> � NDERGROUNDTANK(MONITORINGAREIIAOVAL) M DOG KIENNEL D DAIRY <br /> MAZARMUS WASTE GENERATOR ❑ CHICKEN RANCH 0 NKG TREATMENT PLANT <br /> CJ TIERED PERMITTED FAGILIrV ❑ MOTUIHOTEL ❑ PUMPER TKUcXNAADMHEM TOILETS <br /> 0 TATTOOiDODY PE02GING ❑ P6011SpA ❑ LAND USE APPLICATION SrTES <br /> MEDICAL WASTE FACILITY ❑ PUBLIC WATER 3YSTEM D OTHER(PLLASE SPECIFYABOVE) <br /> 7. hist up to tan addresses in the space above_ Select the type(s)of filo$from the list aboyt:by checking <br /> the appropriate box(es)_ At least one fila typo MUST be selected. x to ZD9 464�Ot38 a it the <br /> address indicated above. <br /> 2. END will notify the applicant if any EHD files exist. All appointment for review will be confirmed <br /> approximately five business days but no later than ten(113) 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 END staff may not be immediately availabls for review, A new <br /> application may be submitted when the fill;Is available_ <br /> Any file not returned in the same condition as released will be roorganialad by EHD staff at the expense <br /> of the applicant_ Future file reviews by the same applicant may require a$37.00 deposit prior to reviCW. <br /> 5_ 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> E. Applications received after 3:00 pm will be processed the next busin®ss day. <br /> I <br /> LONFIR.MED APPOINTMENT DATE TIME. <br /> ATE CONFIRMED PHONE FAX. INrfiAL.S <br /> I <br /> EVIEVvI=p YES NO fir=Yll=w DATE <br /> H Od 4� Of/O7.C10 <br /> 1 <br /> TOTAL P.01 <br />