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_...._.0:/30/2002 13:48 209467111 AGE STOCKTON PAGE 02/02 <br /> \ DATE REGFJVED �w vnocn <br /> V SAN JOAQUIN COUNTYPUBLIC HEALTH SE <br /> FivICES <br /> E VIRONMENTAL HEALTH DIVISION <br /> 4 EAST WEBER AVENUE,THIRD F <br /> STOCKTON CA 95202 <br /> 11 (209) 468-3420 . <br /> PUBLIC RECORDS RELEASE APPLICATION N� <br /> APPLICANT BUSINESS/AGENCY <br /> ADDRESS Q <br /> PHONE ao 9) V10 7&l6 FACSIMILE C z0:40,0 <br /> ^ <br /> TENTATIVE"APPOINTMENT DATE�YII CSI J TIME /D•Q, - <br /> (Ploasa give 7 IQ 10 bush a d from date oI ap licatlon submittal) <br /> CHECK BOX TO FXPFDITE REQUE -S 9.0 �'U RO 1 II f"USINESS DAYS J <br /> SIGNATURE OF APPLICANT DATE ,/ 30 <br /> FILE ADDRESS <br /> 411 <br /> y t AQ LMc ron <br /> a <br /> V�I I <br /> 1i it tt n <br /> \4 MVN <br /> T I - <br /> v • ENVIRONMENTAL HEALTH DIVISION FILES <br /> N OW til . Hv v`4eX <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONRORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL Cl PUMPER TRUCKIYARDICHEM-TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOL/SPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 20 464-0130 or mail to t <br /> hl <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHO 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 EHD staff may not be immediately available for review. A new <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 $78.00 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 <br /> Ell 00 14 MUM <br />