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EMD LUG NUMBER/ <br /> 0AY4 RCL;�JEt) <br /> /SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> L' STOCKTON CA 95202 <br /> (209) 4138-3420 <br /> 2j PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT � d"tom -BUSINESSIAG��ENCY fMoDf'Z /� <br /> ADDRESS `� Q 4 t t \ �►J i?� f`. C--N <br /> t� <br /> PHONE -- 1 ___FACSIMILE <br /> TE+ITATIVO APPOINTMENT DATE 1 �l 71M> <br /> (Piease give 7 to 10 business d a from date of appliC360n submittai) <br /> CHECK BOX TO EXPEDITE REQUES - I FE£-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE( OF APPLICANT <br /> C <br /> ,1/,ORES9 • In'c. <br /> -951k'k �.i�� ��`�©Tt� �Qt�PE R-Z`! �' ?AC' Q.SJ <br /> it tt u tnA�JS _P PDQ N� <br /> - <br /> l>. �' 4 C,�j GAN C_OYY1P t� �1�1T C'ti`7 rPti <br /> I ENVIRONMENTAL HEALTH DIVISION FILES <br /> 71 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ NDERGRC UN TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY 1771 SO1.10 WASTE VEHICLE <br /> CHER CLEANUP SITE(NON-LOP) ❑ 11 KENNEL ❑ DAIRY <br /> p UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLAW <br /> ❑ KAZARDOLS WASTE GENERATOR p MOTELIHOTEL G PUMPER TRUCK(YARDlCHEM TOILETS <br /> ❑ Ti PERMITTED FACILITY p POOLISPA ❑ I-AND USE.APPLICATION SITES <br /> ❑ TATTOOISCODY PEIRCING ❑ PUBLIC WATER SYSTEM d OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> thi:appropriate boxes). At least one file type MUST be selected. Fax to X2051 X64.0138 or mail to the <br /> address indicated above. <br /> 2. EFD 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 application. The files <br /> wi I be hold for a maximum of five business days for review. Appointments should be scheduled <br /> aC:ording ly. <br /> 3. A"ile that is actively being worked on by EHb staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4, Ar y file not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future fila reviews by the same appliC2111t may require a$,T8.00 deposit prior to review. <br /> 5. *TTNTATIVE appointment dates must be confirmed with EHD staff. <br /> g_ Atoplications received atter 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE __ TIME <br /> DATE CONFIRMED _�.---- <br /> PHONE FAX INITIALS <br /> REVIEWED <br /> YES NO REVIEW DATE --� <br /> EH ca 14 WOUi a <br /> TO 119d.5 SS=:9d;;3 hi tI ' '�I�1 H 130--TBS8=,C3, 9-;' :10 0QCA3/.L'2/i,1 <br />