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02/'23/2004 08:24 FAX 209 9.180621 <br />GATE REMVED <br />—,: SAN JOAQUIN GOUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVJSION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />FEB 2 3 2004 STOCKTON CA 95202 <br />(209) 468-3420 <br />ENVIROW//ENT HEAETHPUDLIC RECORDS RELEASE APPLICATIO <br />APPLICANT <br />ADDRESS <br />t6�. <br />z�> E <br />BVGINESSIAGENCY -1 �� <br />-�' r'I'!e— <br />f /�- -S4-re,4— CI -4 <br />0 002 <br />EHD Loc NUMBER <br />lW <br />PHONE _ ` y U I FACSIMMILE <br />TENTATIVE* APPOINTMENT DATE �r 2 el/ /O TIME <br />(Please give 7 to 10 business days from date of application submittal) <br />L) <br />! I % CHECK BOX TO EXPEDITE REQUEST - 387.00 FEE — R QUES PROCESSED IN 7 BUSINESS D•/4(5r <br />SIGNATURE OF APPLICANT <br />� DATE � �3 <br />FILE ADDRESS <br />i <br />T <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />EHD STAFF USE ONLY <br />A ELEMENTS SEARCH <br />I OLID WASTE FACILITY <br />La -'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />'OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACII-ITY �9j LID WASTE VEHICLE <br />UNDERGROUND TANK (MON[TORINGIREMOVAL) C3OG KENNEL :. DAIRY <br />,� AZARDOUS WASTE GENERATOR CHICKEN RANCH C3 PKG TREATMENT PLANT <br />I=RED PERMITTED FACILITY ❑ MOTELJtiOTEL ❑ MPER E XPPL CATION SIM TOILETS <br />LJ TATTOOI9ODY PEIRCING O ' .. OOLISPA LAND USE APPUCA710N SITES <br />l MEDICAL WASTE FACILITY } PUBLIC WATER SYSTEM Q OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkinc <br />the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail a the <br />address indicated above.. <br />2. EHD 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 />w(II 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 no' <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff the experts <br />p <br />of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to revie' <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 />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />TIME <br />PHONE FAX INITIALS ___— <br />REVIEWED YES NO REVIEW PATE <br />