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19�-41 3— �EIJ u�:a�rr1 Fh: 1❑ H.01 <br /> D <br /> ~n . . SAN JOAQUIN COUNTYPUBLIC HF-AI-TH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION I n J N 1 12001 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR� <br /> STOCKTON CA 95242 <br /> (20e) 45s-3420 ENVIP;tIUMEkill hi ALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PER MIT/SEPiViCES <br /> APPLICANT-- 0-u l k♦i Vf e BUSINESStAGENCY. N�_ f^t�Gt 1 <br /> ACTPRESS > 75 � l <br /> r��� P�lw�� -1,�aettitu� , g7 /� t�ecASC� <br /> PHONE ��1—�!^ n?000 �.FACSIMILE <br /> TEN TAT IVErAPPOINThMEN-r DATE ' 1 17 Q i] TIME )a -v p <br /> (Plamt:Diva 7 to 10 pu9ine s days from date of application submittal) <br /> ® CHECK BOX TO EXPEDITE REQUEST 478 Q EE-REgUEST PRbc 9SEp IN 3 SUStNF.55 RAYS <br /> SI13NATURE OF APPLICANT � DATE 1 /�126N <br /> FILE ADDRESS THIS SIPE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEA[%CH <br /> ras~t` <br /> \� 3W Kk bo R04A C lt9h <br /> O! e <br /> -dock-�H 3 Z- <br /> I- I -6 517 <br /> ENVIRONMENTAL. HEAL.TFI DIVISION FILES J�11i 6 <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) to FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDE?RGROUNDTANK IMONITORING/REMOVAL) ❑ DOG KENNEL. D DAIRY <br /> Ea HAZARDOUS WASTE GENERATOR CA CHICKEN RANCH Q PKC TRF-ATMENTP'LANT <br /> IZ TIERED PERMITTED PACILITY ❑ MQTF0iOTEL ❑ PUMPER TRUCKJYARDIPtIEM TOILETS <br /> 0 TATPOOIBODY PHIRCING Q POAUSFA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE PACILITY Q PUai-IC WATER SYSTEM ❑ OTHER(PI-EASE SPECIFY ABOVE) <br /> 1. I-ist up to ten acldrasses in the space above- Select the types)of files from the list above by checking <br /> the appropriate box(es). At feast one file type MUST be Selected, fax to(209) 464-0138 or mal( to the <br /> address indicated at ove. <br /> 2. EHD will notify the applicant if any 9HP files exist. An appointment for review will be confirmed <br /> approximately five busIn®ss days but no tater than ten(10) day$ after receipt of application. The files <br /> will be held for a maximum of five bu;iness days for review, Appointments should be scheduled <br /> acr,ordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be immediately avallttble for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any file not roturned in the same condition as released will be reorganized by EHD staff at tit&UXpensa <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prier to review. <br /> 5. "TENTATIVE appointment dates must be 4onfirmed with EHL}stgff, <br /> 6. Ap,pllcatlons received after 3:00 prn will be processed the next business day. (zcq)46 Y-0 1 <br /> 3 9 <br /> CONFIRMED APPOINTMENT QATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> G/0 - <br />