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SAN JOAQUIN COUNTYPUBLIC HEALTH 5EKVICES <br /> E"' "RONMENTAL HEALTH DIVISION'" <br /> A3ASTWEBER AVENUE,THIRD FLOOR Q�r <br /> STOCKTON CA 95202 R <br /> (209) 468-3420 I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> o I` lZ A G>r 9USINESSIAGENCY M A G-E E N J I R o -41 6 NT A L- <br /> i T <br /> h <br /> ADDRESS P. L'_ T3C'x 8 � � RANC1to �MV' iZ { � tA G!t } Sfo $ 3 <br /> PHONE `�I } 3 S 4- 3 Z So FACSIMILE 9 <br /> a <br /> TENTATIVE`APPOINTMENT DATE I ( 2 T ilTIME I 3 d P M <br /> $ (Please give 7 to 10 business days from date of application submittal) <br /> it <br /> CHECK BOX TO EXPEDITE REQUEST--$$7B.00 FEE'-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> { FILE ADDRESS <br /> `�`f S • W1LSGN W ,�T S ccr:T� N 'I <br /> l <br /> 'I € <br /> k <br /> i <br /> r i <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> dUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> IFT'OTHER CLEANUP SITE(NON-LOP) ! ❑ FOOD FACILITY ❑ SOL10 WASTE VEHICLE <br /> El UNDERGROUND TANK(MONITORING/REMOVAL) ,I ❑ DOG KENNEL ❑ DAIRY <br /> G3'HAZARDOUS WASTE GENERATOR 13CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 171PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO180DY PEIRCING ❑ POOUSPA 13LAND USE APPLICATION SITES <br /> ❑ MEOICA L WASTE FACILITY ❑ PUBLIC WATER SYSTEM 173OTHER(PLEASE SPECIFY ABOVE) <br /> I, 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> i 2. EHD will notify the applicant if any lhEHD files exist. An appointment for review will be confirmed <br /> 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 /> accordingly. <br /> 3. A file that is actively being worked!i!on by EHD staff may not be immediately available for review. A new ' <br /> application may be submitted when the file is available. E11 I <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 $78.00 deposit prior to review. i <br /> 5. TENTATIVE appointment dates must be confirmed with EHD staff. i <br /> 6. Applications received after 3:00 pm will be processed the nett business day. r <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> f REVIEWED YES NO REVIEW DATE <br /> Ex 00 is 01106M0 <br /> t <br />