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09/17/2003 09x36. 17AX 2091-94:8.0621X002/004 r <br /> ' oAr1:RECF_EYU - i} 9160 LOG twuaFR <br /> 1] iC l � SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEHER AVENUE,THIRD FLOOR <br /> s E P 17 2003 STOCKTON CA 95202 I, <br /> fqq7 <br /> (209)4683420 <br /> .LtjV (1,0%)ENI HEALTHPUBLIC RECORDS RELEASE APPLICATION ' <br /> t� l I, <br /> AFPLICATIT 8USINVS51AGENCY <br /> ADDRESS } <br /> j PHONE Z O 1 `�]i-(`r� 1-3!1 FACSIMILE 209 � L3 6 'L 1 <br /> TENTATIVE*APPOINTMENT DATE .17ME <br /> (Please give 7 to 10 buslness days from data of applha8on submittal) <br /> j# <br /> C3 CHECK BOX TO EXPEDTrE REQUEST-$ 7.pp F - REQUEST PROCESSED IN 3 BL. E5S'�13AY5 <br /> { <br /> SIGNATURE <br /> OF APPLICANTI DATE <br /> �a iI <br /> FILE ADDRESS I THIS SIDE E}iD STAFF US>w ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 3 " ( 7 A �l 3 <br /> CA LL f p rZ,41� 1- <br /> Coor, ! f, 1, E <br /> 11 1 , t Ll f, <br /> Lo 5(0 �q <br /> IA j L/t L^sit-j{'f'j' .C'.l r r r L_- I` <br /> ENVIRONMENTAL HEALTH DIVISION1FiLES. <br /> 1% UNDERGROUND TANK S CLEANUP SITE LOP C1 HOUSING ABATEMENT } Ik sawn WASTE FACILITY <br /> 61OTHER CLEANUP 5TrE(NON-LOP) IO FOOD FACILRE3 SCUD WASTE vEHI=Y - '� Oa DAIRY <br /> TANK(MONITORINGIREMOVAL) Cl DOG KENNEL <br /> IiAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH W FKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY 17 MOTEL/HOTEL fl ❑ PUMP ER TRUCKlYARDICHEM TOILETS <br /> TATTOOMODY PEIRCENG 0-POOLISPA. 2 LAND USE APPLICATION SrCES <br /> 13 MEDICAL WASrE FACILITY ID PUBLIC WATER SYSTEM 0 OTHER(PLEAsE SPECIFY ABQvE) <br /> - i <br /> 1. List up to ten addresses In the space above. Select the type(s)iof files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Faxl to 209 464-01313 or mall to the <br /> addresslodicatad above.. 6 <br /> 2. EHE)will notify the applicant if any EHD files exlsL An appointr�ent 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 Feld for a maximum of five business days for review. Appointinents should be scheduled <br /> accordingly. I <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new <br /> applicatlon may be submitted when the file Is available. 'I <br /> 4. Any file not returned in the salve condition as released will be reorga ized 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 rev[ew. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. p <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT l7ATE TIME.• <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO RIEVIEW DATE . <br />