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DATE R&CEEVEn EF7,04� tiUMt3ER <br /> \ SAN JOACUIN COUNTYPUBLIC HEALTH SEF :ES ' <br /> V ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I L <br /> STOCKTON CA 95202 0G,, <br /> (209)468-3420 !�b`I I <br /> PU LIC RECORDS RELEASE APPL-ICAIi ION <br /> APPLICANT RUSINESSIAGENCY phc js!L� Tor— <br /> ADDRESS V itP <br /> PHONE SpL4 - FACSIMILE <br /> TENTATIVE'APPOINT ENT DATE TIME <br /> (P easa give 7 to 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQ EST-$75.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> OP <br /> SIGNATURE OF APPLICANT �z.,2 ---- DATE I <br /> FILE ADDRESS <br /> t -T�QG G <br /> 22 <br /> ( ;n, r _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 181 UNDERGROUND TANK( ST)C NUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 0 SOLID WASTE VEHICLE <br /> 19 OTHER CLEANUP SITE( ON-I-OP) d FOOD FACILITY 0 DAIRY <br /> ;9 UNDERGROUND TANK(MONITOR[ GIREMOVAL) © DOG KENNEL O PKI TREATMENT PLANT <br /> Ig HAXARDOUS WASTE GENERATO ❑ CHICKEN RANCH [3 PUMPER TRUCKrYARDlCHFM TOILETS <br /> InTIERED PERMITTED FACILITY O pOOL L1HOTEL O LAND USE APPLICATION SITES <br /> ❑ TATTOOtSODY PEIRCING [IOOLA ❑ OTHER(PLEASE SPECIFY AEON[:) <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM <br /> eb <br /> 1 List up to ten addres s in the space above. Select the type(s) of files from the list above by ch Elcking <br /> the appropriat®box( s). At least one file type MUST be selected. FDX to (209 464-0138 <br /> or mail :!�the j <br /> address indicated ab ve. <br /> 2. EHD will notify the a0plicant ifany fEHDn files <br /> rthan ten (xist. An 10) days afteent r receipt of applications Th: files <br /> approximately five business days will be held for a maximum of five business days for review. Appointments should be schedules <br /> accordingly. not be immediately available for review. A new <br /> 3, A file that is actively being worked on by EHD.staff may <br /> application may be submitted when the file is available. staff at the <br /> 4. Any file not returned'in the same condition as released will <br /> r r ueogaireza $8.00 deposit pr or to review. <br /> of the applicant. Future file reviews by the same app ma Y seq <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> FDAE <br /> ONFIRMED APPOINTMEN$ DATE TIME <br /> NFIREDPHONE FAXINITIALS <br /> TCOM <br /> REVIEWED YES NO REVIEW DAT�� <br /> EH 00 14 OM540 <br />