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v7!22/2002 10:22 FAX 209 948 0621 KLEINFELDER _ 0002/002 <br /> GATE RECEIVED ••� EtW L lill <br /> MBM <br /> 3a SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICF-S 11 q30 <br /> Pq ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 85202 <br /> (209)4683420 WED <br /> PUBLIC RECORDS RELEASE APPLICATION v <br /> APPLICANT �P ,� <br /> rr/C Z� BUSINESS/AGENCY <br /> ADDRESS 2$ s ALM /c s� 1 HEALIN <br /> PHONE 918- /3ys FACSIMILE ENVIRO RVICES <br /> TENTATIVE*APPOINTMENT DATE <br /> laq A0r TIME <br /> (Pladbc ir0 ,6usdays �Q. PUon submittal) <br /> rs <br /> 13 CHECK BOX TO EXPEDITE REQUE,SS�.0�0 FEE—*^REQUEESSTJP�R S3ED IN 3 SINE�5.5 DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT r y <br /> FILE ADDRESS THIS SIDE EHO STAFF U ONLY <br /> PROGRAM ELEMENTS <br /> V 9W/ LO Al CSI; ern:n loct�fe 4 <br /> I <br /> IS Cp.f:FO rn:w Lcien C.4 <br /> kockJvn 'R++•..1 Ct cr+e�-er �o.r� . _. <br /> L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> .SNG ENT SOLID WASTE FAhILRY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 FO <br /> ODI <br /> s� SOLID WASTE VEr <br /> CLEANUP tCLE <br /> OTHER CLUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY i <br /> UNDERGROUND TANK(MONITORINGrttEMOVAL) CI CHICKEN RANCH ❑ PKG TREATMENT'PLANT <br /> IW7AARDOUS WASTE GENERATOR 171MOTELIHOTEL A:r ❑ PUdIPERYRUCK/t'ARDfCHEM TOILETS <br /> TIERED PERMITTED FACIIJTYPA ❑ LAND USE APPLIt.A11ON SITES <br /> ❑ TATTOO/BODY PEIRCING C3 POO13 PUBLIC WATER R SYSTEM I OTHER(PLEASE SPECIFY ABOVE) <br /> ArMEDICAL WASTE FACILITY <br /> 1_ List up to ten addresses in the space above. select <br /> l t thhee type ted.of Fa�0020 46 the 1138 orabove 6yaiht Checking <br /> the appropriate box(es). At least one file type <br /> address Indicated above JJ <br /> 2_ EHD will notify the applicant if any EHD files exist An appointment for review wille confirmed <br /> approximately five buslness days but no later than ten (10)days after receipt <br /> Shoup beasohadu edflles <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. y available for review. Anew <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately <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 EHosteff t th to Pense- <br /> of the applicant Future file reviews by the same applicant may require a$87.00 d 1p <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 /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />