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AUG 0 5 2003 <br />'PLICANT <br />SAN JOAQUIN COUNTY <br />ENVIROI ENTAL HEALTH DEPARTMENT <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY <br />)DRESS /y 7 X/ r c 2 2/ d n -1, 0 11 <br />IONE T -� / — L, f FACSIMILE 23 I <br />TENTATIVE' APPOINTMENT DATE TIME ` <br />(Please give 7 to 10 business days from date of application submittal) ' <br />(CHECK BOX TO EXPEDITE REQUEST • 89.00 FEE EQUUUEST P CES D IN 3 BUSINESS DAYS , <br />GNATURE OF APPLICANT /a .�ZTY1) 4 1Sj DATE <br />ADDRESSFILE <br />PROGRAM ELEMENTS SEARCH <br />iinI rrrr, <br />ly' T7�1l11�IMI'�I1r 011,10, <br />mom <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT <br />❑ <br />SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ <br />FOOD FACILITY <br />❑ <br />SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ <br />DOG KENNEL <br />❑ <br />DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />❑ <br />PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />❑ <br />MOTEUHOTEL <br />❑ <br />PUMPER TRUCK/YARD/CHEM TOILETS <br />TATTOO/BODY PEIRCING <br />❑ <br />POOL/SPA <br />)LL <br />LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY <br />❑ <br />OTHER (PLEASE SPECIFY) <br />List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />address indicated -above. -' <br />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 />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />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 $89.00 deposit prior to review. <br />'TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />:)NFIRMED APPOINTMENT DATE <br />JE CONFIRMED <br />-VIEWED YES NO <br />12003 <br />TIME <br />PHONE FAX INITIALS z `'TeZyft <br />REVIEW DATE <br />