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ATE RE to EK00 Mums" <br />JOAQUIN COUNTYPUBLIC HEAL AERVIC <br />ENVIRONMENTAL HEALTH Di .�N <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(208) 468-3420 <br />_ PUBLIC RECORDS RELEASE APPLICATION <br />,� ' G' e,� a UGC 1`� n w0. s 4-c <br />APPLICANT �,��.1 S �j„'`�''4� ) BUSINESS/AGENCYy �Q � �ad <br />ADDRESS, 91:a /J. <br />PHONE(a69)137, 7 31A FACSIMILE LID <br />TENTATIVE* APPOINTMENT DATE AS t 1 P tAi°AV. F TIME _ /A <br />(Please give 7 to 0 businestTT <br />rN <br />licatlon submittal) <br />jr <br />® CHECK BOX TO EXPEDITE REQUEST - SWO- BUSINESS DAYS <br />SIGNATURE OF APPLICANT2n�..ca. Yc eDATE 6 2 <br />a <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 12 SOLID WASTE FACILITY <br />Q OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY ® SOLID WASTE VEHICLE \`® <br />❑ UNDERGROUND TANK (MONtTORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ® PKG TREATMENT Pt:/WT <br />❑ TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOiLETS <br />® TATTOO/BODY PEIRCING O POOUSPA 61 LAND USE APPLICATION SITES <br />Q MEDICAL WASTE FACILITY 0 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 akiave by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to 208 464-01 jj or mail to the <br />addre s indicated above. G" <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 appilcation. The files �N' <br />will be held for a maximum of five business days for review. Appointments should beScheduled <br />accordingly.° <br />3. A file that is actively. being worked on by EHD staff may not be immediately available for review. A new <br />application may be submitted when the file Is avaliable. <br />4. Any file not returned in the same condition 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 />5. *TENTATIVE appointment dates must be confirnied with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />DA'L'E CONFIRMED <br />REVIEWED YES NO <br />TiMIM ' <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />Z/Z 96ad `.85:91, Z0-LI-AeW !Z6CLLC660Z •`SNdOM#onsnd#N01N3019#J0#,11I3 :As jun <br />