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10/3B/2002 14:21 <br />464013',... ENVIRONMENTAL HEAL` <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209)468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT <br />�1 It"' FC, 1—TF-'-rn` BUSINESSIAGENCYy} 1 f7c <br />ADDREsS,,2ArS HP-&aI?o �1^4-tom AL -LL 1 /c <br />PHONE C �' &02 —933 3 FACSIMILE q�2- 3 — 6 <br />PAGE 01 <br />too? I,% W Ge <br />lu U� 5 <br />I/I�UI NOV 0 12002 <br />TENTATIVE' APPOINTMENT DATE IIIA I �QZ TIME `%'� <br />(Pica&* Rive T to 10 6ualn sada Gem dale of application submnla4 <br />El CHECK BOX TO EXPEDITE REQ EST -'IP E EQUEST 110j. 14IRS Ift 40 <br />3 <br />A)ou.15, Z'00)- <br />SIGNATURE <br />'00z <br />SIGNATURE OF APPLICAN � � IATE IC 31 02_ <br />ENVIRONMENTAL HEALTH DIVISION FILES NOV 12 2UUZ <br />O <br />N <br />O <br />N <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) D FOOD FACILITY O SOLID WASTE VEHICLE <br />JIQ UNDERGROUND TANK (MONITORINGIREMOVAL) IT BOG KENNEL O DAIRY <br />O HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKO TREATMENT PLANT <br />O TIERED PERMITTED FACILITY O NOTELIHOTEL ❑ PUMPER TRUCKIYAROICHEM TORETS <br />O TATTOOIBODY PEIRCING O POOLISPA O LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY . O PUBLIC WATER SYSTEM O OTHER (PLEASE SPECIFY ABOVE) <br />7. List up to ten addresses In the space above. Select the type(a) of riles from the list above by checking <br />the appropriate )Iox(es). At least one Filo type MUST be selected. Fax to (209) 464-0938 or milli to the <br />address Indicated above. <br />2. EHD will notify the applicant it any EHD Files exist. An appointment for review will be confirmed <br />approximately live business days but no later than ton (90) days after receipt of application_ The files <br />will be Mold for a maximum of five'buslness days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that actively being worked on by EHD stair may not be Immediately available For review. A now <br />application may be submitted when the fila Is available. <br />4. Any file not rollimild in the same condition as rebased will be reorganized by EHD star at the expense <br />or the applicant Future fila reviews by the same applicant may require a $89.00 deposit prior to review. <br />S. `TENTATIVE appointment dates. must be confirmed with EHD staff. <br />6. Applications received after 3:01) pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE. TIME. <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />I -d <br />dLP=SO 20 16 '00 <br />T141S SIDE END STAFF 6511 ONLY <br />PROGRAM ELEMENTS SEArICH <br />elm <br />�7 <br />ar:aravifcti� <br />�1e .�7G �� . <br />1111111111111111 4 . <br />t ' <br />I}�p�e�*�flrL^iyI�M <br />-� ,WO�laWI��1111111111111 <br />�MaAied <br />LAW <br />�r3f�fFri�IMIlAkyIUGJI1�71`Nli l� <br />v uLrnIjL1L711 I <br />ENVIRONMENTAL HEALTH DIVISION FILES NOV 12 2UUZ <br />O <br />N <br />O <br />N <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) D FOOD FACILITY O SOLID WASTE VEHICLE <br />JIQ UNDERGROUND TANK (MONITORINGIREMOVAL) IT BOG KENNEL O DAIRY <br />O HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKO TREATMENT PLANT <br />O TIERED PERMITTED FACILITY O NOTELIHOTEL ❑ PUMPER TRUCKIYAROICHEM TORETS <br />O TATTOOIBODY PEIRCING O POOLISPA O LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY . O PUBLIC WATER SYSTEM O OTHER (PLEASE SPECIFY ABOVE) <br />7. List up to ten addresses In the space above. Select the type(a) of riles from the list above by checking <br />the appropriate )Iox(es). At least one Filo type MUST be selected. Fax to (209) 464-0938 or milli to the <br />address Indicated above. <br />2. EHD will notify the applicant it any EHD Files exist. An appointment for review will be confirmed <br />approximately live business days but no later than ton (90) days after receipt of application_ The files <br />will be Mold for a maximum of five'buslness days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that actively being worked on by EHD stair may not be Immediately available For review. A now <br />application may be submitted when the fila Is available. <br />4. Any file not rollimild in the same condition as rebased will be reorganized by EHD star at the expense <br />or the applicant Future fila reviews by the same applicant may require a $89.00 deposit prior to review. <br />S. `TENTATIVE appointment dates. must be confirmed with EHD staff. <br />6. Applications received after 3:01) pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE. TIME. <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />I -d <br />dLP=SO 20 16 '00 <br />