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ATL' RE E1VED a. EHI�`AQ t1tJM1�F,A <br />JOAQUIN COUNTYPUBLIC HEALA-3ERVICESio, <br />Ono* <br />ENVIRONMENTAL HEALTH N <br />304 EAST WEBER AVENUE, THIRD FL <br />STOCKTON CA 95202 <br />(209) 466-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />z I tri i, M, <br />APPLICANT yr a,S k-. V kt-)n -BUSINESSIAGENCY e <br />AADDRESSa <br />6.-Skl�z f <br />PHONE L-':01) 13 7 - -2 o FACSIMILE fr C/7 <br />TENTATIVE* APPOINTMENT DATE ASA -f- M.W. TrMF- <br />(Please give 7 <br />to,10 business d sfr lication Submittal) <br />TPI, <br />CHECK BOX TO EXPEDITE 98QUEST-Aw- /W TPRMM"N 3 BUSINESS DAYS <br />1 <br />SIGNATURE OF APPLICANT DATE 5 6-2. <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />0 UNDERGROUND TANK (UST) CLEANUP SM (LOP) M HOUSING ABATEMENT 12 SOLID WASTE FACILITY <br />13 OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY C3 SOLID WASTE VEHI�LFE �`:.• <br />0 UNDERGROUND TANK (MONrTORINGIREMOVAL) 0 DOG KENNEL C3 DAIRY <br />13 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 8 PKG TREATMENT kNT <br />C3 TIERED PERMITTED FACILRY 0 MOTELIH07EL 0 PUMPER TRUCKIYARDICHEM TOILM <br />0 POOLISPA 9 LAND USE APPLICA;.nON SITES <br />P TATTOOIBODY PEIRCING <br />0 MEDICAL WASTE FACILITY M PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) <br />I List up to ton addresses In'the space above. Select the type(s) of files from the list abpve by checking <br />the appropriate box(es), At least one file type MUST be selected. Pax to (209) 464-01 a at mail to the <br />address indicated above. <br />2. EHO Will notify the applicant If any END files exist An appointment for review will be ronfirmed <br />approximately five business days but no later than ton (10) days after receipt of appllciation. The files <br />will be hold for a maximum of five business days for review. Appointments should be.schaduled <br />accordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately available for review. Ane <br />application may be submitted when the file Is available. <br />4. Any file not returned in the same condition as released will be reorgafilzed by EHD stiff 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 appointment dates must be conflrffied with EHD staff. <br />G. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIM9 <br />DATE CONFIRMED <br />PHONE PAX <br />I <br />INITIALS -: <br />?/Z OBOd !99:9t ZO-Li.-Aerl !Z66LLl3660Z !sNuom#on9nd#N01>1301S#J0#A1I3 :A9 jueS <br />