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09/02/2003 07:32 5592687;126 TWINING LASS PAGE 01/0 <br />10-17-2000 <br />f? ?A FEi TO l.5592Ge?i26 P.02 <br />ISAN ,IOAQUIN COUNTYPUBLIC HEALTH SERVICES `HV `�NVMYiGk <br />ENVIRONMENTAL HEALTH DIVISION <br />SEP 0 2 2003 304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 93202 <br />ENVIRONMENT HEALTH (los) 468-34io Zo5 - L(C �(� � j � � <br />REftMi�IsfRVICES PUBLIC RECORDS REI,EAS� APPLICATION <br />APPLICANT 13US1NF.SSlAGENCY _-f j <br />ADDRESS ? R'7 % C <br />PHONE=' _ ) FACSIMILE <br />TENTATIVI*' APPOINTMENT DATE /2' S lI 1 <br />(PI9250 Hive 7 10 10 basins. da: <br />CHECK BOX TO EXPEDITE REQUES-_$" FEE- REQUEST PROCRSSED IN 3 13USINESS GAYS v� <br />SIGNATURE OF APPLICANT <br /><- �— - DATE <br />' ! J <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />ij�'UNI SRGRQUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (HON -LOP) ❑ FOOD FACUJTf ❑ SOLID WASTE VEHICLE <br />6M\1JNDaRGRQVND TANK (MOf4IT0R1NQfgFmOVAL) ❑ DOG KENNEL EI DAIRY <br />WAM GFNERATOR 0 CHICKEN RANCH EI <br />PKI7REA7M&NTALANT <br />❑ TIEPEDPERMITTEDFACILITY ❑ MOTELIHOTEL 0 PUbMPERTRUOWYARMCHEMTOILET$ <br />C TATTOOISODY PEIRCiNO ❑ POOVSPA - O LAND USE APPLICATION SITES <br />C MEDICAL WASTE FACILITY 'Q PUBLIC WATER SYS7ED4 13 0114ER (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 eheahing <br />the appropriate box(es). At least one file typo MUST be selected. Fax a 2D9 4 <br />94-013tpr Mqjl to the <br />ag—dress i ve. <br />2. EHD will notify the applleant 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 />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 EHO staff may not be immediately available for review. A new <br />applicatlon may be submitted when the file I5 available. <br />4. Any file not returned in the same condition as released:will be reorganized by E140 staff at the "Penne <br />of the applicant. Future file reviews by the same appll4nt may require a $187.00 deposit prior to review, <br />b• 'TENTATIVE appointment dates must be contirmad with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. ' <br />CONFIRMED APPOINTMENT DATE illlsl= <br />¢ATE GONFIRMEp PHONE FAX INITIALS <br />- <br />EVIEWED YIrS NO - REVIEW DATE <br />- I ,0 <br />