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t,U <br /> SAN . QUIN COUNTYPUBLIC HEALTH RVICES <br /> AVIRONMENTAL HEALTH DIVISI_ �Qu� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> lit STOCKTON CA 95202 <br /> (209) 4683420 <br /> PUBLIC RECORDS RELEASE APPLICATIQ I -.„ - <br /> APPLICANT � nn� u S BU31NlC3S�AOENCY (y 2/5- <br /> J l <br /> ADDRESS 0 / SA <br /> tl <br /> �~f��L� FACSIMILE U! 7[J� I !!�O ` c <br /> PHONE /) <br /> TENTATIVE`APPOINTb1'8NT DATE <br /> f Q, TIME t/•r� ✓► <br /> (Please give 7 to 10 burin -s days from date of application subm'"O <br /> CHECK BOX TO EXPEDITE REQUES 78.00 FEE-REQUEST ROC SSE D IN S HUStNESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> �r rr � a9•S3 < <br /> " T <br /> _ o p <br /> If <br /> It r r t t r 3S fin, <br /> t/1 er -e !t <br /> / e _ <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> ❑ SOUD WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ NdUSING ABATEMENT ❑ SOLIa WEE VEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) ❑ FOOD FACILITY <br /> d. DOG KENNEL ❑ PKGDAIRY <br /> T <br /> UNDERGROUND TANK(LtONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKp.IOTEJNOTEL ❑ PUMPER TRUCK/YAKWCHEM TOILETS <br /> D TIEREp PERMITTED FACILITY ❑ POOLlSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING ❑ PUBL}C WATER SYSTEM la OTHER(PLEASE SPECIFY AHOVe) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses irl the space above. Select the type(s) of files from the list above by chocking <br /> the appropriate box(es). At least one file type MUST be selected_ Fax to (209) 464-0138 or mail to the <br /> ~p dress indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An-areceipt of appppointment for review will bllic am The files <br /> approximately five business days but no later than ten(10)days after <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A filefhat is actively being worked on by EHD staff MAY not be immediately available for review. A new <br /> application may be su6•mitted when the tale is available. <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 $75.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6.. Applications recolvsd after 3:00 pm will be processed the next business day. <br /> F <br /> NFIRMED APPOINTMENT DATE �� TIME <br /> TE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> FN 04 14 01i = <br />