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06/17/2004 11:34 FAX 209 94806 0 4002/002 <br /> s:nO roc xwaea <br /> � �s�J jj DSAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION I <br /> JUN 1 7 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> EN""11""' HEALTH (209) 468-3420 <br /> PLBMI PU6LIC RECORDS RELEASE APPLICATION <br /> APPLICANT n a BUSINES-51AGFNCY <br /> ADDRESS b` � 9 <br /> PHONE 77 J �7 FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE l� �S b TIME <br /> (Please give 7 to 10 buslnoss days f om date of spplicatlon submitral) <br /> CHECK BOX TO EXPEDITE REQUEST 4"FEE—REQUEST PROCESSED IN J BUSINESS DAYS ' <br /> SIGNATURE OF APPLICANT <br /> /LdLUCC4 � O/St It DATE 71e <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS 5EARGH <br /> Saor4 eAy <br /> 3S� n/ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT [3 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 12FOOD FACILITY �0 SOLID WASTEYEHICtF <br /> UNOERGROUNO TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HIERED 0UMFTfED GENERATOR OR 0 MOTELIHOTEL 0 PUMPER TRUCKTYARDICHEM TOILETS_ <br /> ❑ TIERED PERMITTI_D FACILITY 0 LAND USE APPLICATION SITES <br /> ❑ TATroomoDY PFIRCING r]'p00L15PA " ' p OTHER(PLEhSESPECIFYADOVE) <br /> CI MEDICAL WA5TE FACILITY ElPUSUC WATER SYSTEM <br /> type(s)of files from the list above by checking <br /> �. List up to ten addresses In the space above. MUSTthe <br /> be selected. Fax to 209 484-0136 or mall to he <br /> the <br /> appropriate box(es). At least one file type <br /> address indicated above. . <br /> appoin <br /> ew will he confirmed <br /> 2 notify the applicant if any FHD files e <br /> appy xiim tely five business days but no later than ten (0)days after daysent for 1pt 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 EHD staff may not be immediately available 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 will be reorganized by EHD staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a$87.00 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 /> CONFIRMED APPOINTMENT DATE TIME, <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE ^T= <br />