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11t)/,_U/LUU4 11:56 YAA LUH >041JUM <br /> i <br /> GATE R=A01E + I� `. EFS LOG NUMBER <br /> F // XN JOAQUIN COUN- YPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 3 a z�Q4 304 EAST WEBER AVENUE,THIRD FLOOR' <br /> STOCKTON CA'#5202 <br /> EfLVIRU f�'1Ei`J' HtE,L3H (20914:0-3420 <br /> PERfvli TjSERV10EJ�DBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT _ BUSiNESSIASEt+ICY .. I_ _ <br /> ADDRESS_ �i�b7i�v �G . ''�.�t l �1 G-r-a r k <br /> ,ONE �(i ~ ��k'S -- FACSIMILE �i K �O b -Z_ <br /> 1 _ <br /> { <br /> I Ija Tlrun>= <br /> TENTATIVE{APPonN•t•MENT DATE_ i 7.t3� <br /> j (Please give 7 to 10 business days front date of appiicallon submittal) <br /> t <br /> CHECK BOX TO EXPEDITE REQUEST-;8T.00 F —RECUEST OCESSED IN 3 DUSINESS DAYS <br /> i. <br /> S GNATURE OF APPLICANT DATE 466��Za <br /> FILE ADDRESS THIS SIDE EHD sTAFi=jOrz ONLY <br /> Mr:N EARCH <br /> 1 AV ti z — 112 -10 - <br /> LL l< 1 r <br /> ASO tiff t-i c)a it ` <br /> P t vv �. <br /> S+ { Y 1 <br /> JL L& L. <br /> i - <br /> I ENVIRONM ENTAL HF_Ai.TH DIVISION FILES-7 <br /> I <br /> UNDERGROUND TANIC(UST)CLEANUP SITE(LOP) C HOUSINGABATEMENT M SOLID WASTE FACILITY p <br /> p4 OTHER CLEANUP SrrE(NON-LOP) E] FOOD FAclmY o SOLID WASTE VEHiCI.E _ s <br /> UNDERGROUND TANK,(MONITORINGIREMOVAL) O DOG KENNEL Q1 DAIRY too <br /> ❑ CHICKEN RANCH Ur PKG TREATMENTPLART <br /> HA74R4411S WASTE GENERATOR ❑ EAOTELhIOTEL , [7 PAMPER TRL3C)CIYARDICH OIL-MS <br /> C4 TIERED OODYPERmT I CtNG FACILITY -t_AXD USE APPLtGAlnoN SrtES <br /> ❑ MEDICAL WAS F F C ILI Q'pUSUC W a OTHER(1>LFASE SPECIFY ABOVE) <br /> C! MEDICAL WASTE FAcltmf 1� Puauc 114(A'1"ER SYSTr=M <br /> 1. List up to tern addresses In the space above. Select the type(S)of,fiies from the list above by checking <br /> the appropriate box(es). At least one MO.type MUST be selected. Fax to 209 4 38 or mail to Ile <br /> address indicated above.. <br /> 21 EHD will notlfy-the applicaht i;any EHD flies exist. An appointment for review will 61Q confirmed, <br /> i 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 /> I accordingly. <br /> S. A file that is actively being worked on by EHD staff,may not be immediately available for review. A nev, <br /> application may be submitted when the file Is available. <br /> 4� Any file not returned In the same condition as releasedl -reorganize$87Y 0 depo stait prior to at the P �^ <br /> of the applicant. Future file reviews by thb same Applicant may require <br /> 'TENTATIVE appointment dates must be.confirmed with EHD staff. <br /> Applications received after 3:00 pM VI if ba.processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX' INITIALS ______, <br /> REVIEW DATE <br /> � <br /> REVIEWED YES NO <br />