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u�r <�i cvuo 11.ul 40401J0 LNVINUNMLNIAL HEALTH PAGE 01 <br /> DATE RECEIVED AN JOAQUIN COUNTY <br /> 1,�� <br /> - RF E� qq �[� ENVIhJMENTAL HEALTH DEPARTMEN <br /> IS <br /> u u 304 EAST WEBER AVENUE,THIRD FLOOR � y" <br /> AUG 16 2004 STOCKTON CA 95202 ( �Q C <br /> (209)468.3420 <br /> r, PUBLIC RECORDS RELEASE APPLICATION <br /> N rIE';i hilt ,, <br /> PERMIT/ \\� mss h G�� Gco1 ;ate <br /> APPLICANT-R,-c.��I �'�- � BUSINESSIAGENCY <br /> S 3 <br /> (ADDRESS \wl <br /> s <br /> 'PHONE ZO`� 22. FACSIMILE -Lu cj2Z— 7 <br /> VJ \\ Schyj\n\L-- <br /> TENTATNE"APPOINTMENT DATE U 2 ;fin S p TIME <br /> Lo <br /> (Please give 7 to 10 business days from date of application submittal) <br /> 83.00 t 1 <br /> CHECK BOX TO EXPEDITE REQUEST-S FEE\REQUEST PROCESSED IN 3 BUSINESS DAYS $ 121 <br /> !SIGNATURE OF APPLICANT '" \1� DATE <br /> THIS 111SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH �f <br /> Slt LOD't P <br /> Lk a, <br /> 14V -7 JL <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ■ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ :3 SOLID WASTE FACILITYHOUSING ABATEMENT ❑ SOLID WASTE VEHICLE <br /> * OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ DAIRY <br /> * UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ pKG TREATMENT PLANT <br /> i HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ LAND SE APPLICATION SITES / <br /> ❑ POOLSPA <br /> ❑ TATTOOIBODYPEIRCING �' <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)Of files from the list above by checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the <br /> address indicated above. y for review will be confirmed <br /> 2. EHD will notify theapplicant If an EHD files exist, appointment0 lays after receipt of application. The files <br /> approximately five business days but no later than ten ( ) Y <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 on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available- <br /> reorganized by EHD staff at the expense <br /> 4. Any file not returned In the same condition as released will be <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <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 /> LDATE <br /> MEb APPOINTMENT DATE TIME <br /> FIRMEDPHONEAX INff1ALS <br /> D YESNO REVIEW DATEoD4U- ` <br />