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0srOT/2003 08:80 FAS 209 9480821 <br /> EMo BOG HW4ER <br /> 'A�"E�EO - - "-'-` SAN JOAQUIN COUNTYPUBLIC HEALTH SER'/ICES <br /> ENVIRONMENTAL, HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ti�AY 7 2003 STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELF-ASE APPLICATION _ <br /> _ $ 13UsINESSIAGENCYF'f:^�✓ --moi -� <br /> APP❑CANT �'�V L--1 \ — C c7 c Z o <br /> ?-b2, <br /> S S4'o CJI , <br /> ADDRESS `rj - 2.I <br /> PHONE ?_.� 4.'4.� 13�tr —FACSIMILE <br /> sQ TIME -L?-'.J 17 <br /> TENTATIVE`APPOINTMENT DATE kT a of�PPnmtlon sUbm ttL) <br /> (Please BWe 7 to 10 uslness ear, � '� I� f 3' <br /> CHECK BOX TO DxPEDITE REOU[ST- .00 -REQUEST P SFA IN 7 BUSINESS OA'f5 -x/` <br /> _ OAT,_ <br /> SIGNATURE OF OF APPLICANT <br /> THIS SIDE EtIO STAFF U5£ONLY <br /> FILE ADDRESS -' PROGRAM ELESI-EMS SEARCH / <br /> tILI <br /> y <br /> 0 _ <br /> Oka I F42, Q 7 <br /> zp rS - <br /> AYE G, <br /> k , O gyp gi <br /> S - . <br /> ENWRONNIENTAL HIJI.LTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT In 50I_10 WASTE FACILITY - <br /> L@ UNDERGROUND TANK(UST)CLEANUP 517E(LOP) 13 FOOD FA�❑TY C; S07_10 WAS I'E VEHICLE <br /> MOTHER CLEANUP SITE(NON-LOP) LI OOG KENNEL 69 DARY <br /> � UNDERGROUND TANK(MONIYORINGIREMOVAL) ❑ CHICKEN RANCH ,r3, PpS TREATMEIIT PLANT <br /> Lft HAZARDOUS WASTE GENERATOR O MQ ELR-1 RAN ❑ PU',tIP?RTF.UCFVYARDICHEMTOILETS <br /> ❑ TIERED PERMnTED rACtt17Y p FOTEtITT4 '. - . LAIr.D USEAPPUCATION Snrs <br /> ❑ TATTOOlBOOY PEIRCING FI EO YIATF.R SYSYEOA ❑ OT1�EIt(PIJASE SPECIFYAIIOVE) <br /> ❑ MEDICAL WASTE FACILITY Pk <br /> 1. List up to ten addresses In the space above. :elect the types) of files f om tF 64lisabove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax tgi�4' -0 38 Or mail to the <br /> address indicated above. <br /> 2. EHD wilt notify the applicant it any EHD files exist_ An appointment for retrieve Will blicat nmtThe files <br /> approximately five business days but no later than ten(10) days after rr,eipt of application- <br /> wit[ <br /> pp <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 avLllable for review_ Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released wile I opgailied 7y60 deposit prior texfe nse <br /> of the applicant. Future file reviews by the same app mayrequire <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 6- Applications received after 3:00 pm will be processed the next business day_ <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> ocincvucn vcc n <br /> ocnmunnrC .� Xes IIINq ir7 <br /> 87,03: Lg-R rhes ql�L {o w r <br /> 15-Ib-03`. 1:IdCAn Ir wall 10d' <br />