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Jun l$ 203Y i,C 02P <br />D/1TE'IILGGYYJ <br />RD <br />JUN 18 2004 <br />M v'#W RO 209.369.4228 <br />SAN .lOAQUiN COU NTYPUBLiG HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />344 EAST wEf31'R AVENUE. THIRD FLOOR <br />STOCKTON CA 95202 <br />(249) 485-3420 <br />Pi tai 1[: RECORDS RELEASE APPLICATION <br />Ido 5532 P- 2 <br />E14D icon M &MFft <br />a,�1�1��,I•t � � ."�� �.,+� �, suslN�ssrA��cv � <br />� 0 <br />ADDRESS 0 2 zed GS }rI GN W_ °,� <br />v, <br />PHONE FACSIMILE <br />r- <br />�1© 1 Y3 b <br />TENTATIvi aPvOita=NT DATE <br />(Pto <br />{PSaace p;vr T data of ippliCati4;a' gl11mitt3i) <br />❑ GgiECK 13OX TO E]CPEDlTE REQUEST 8 F- - R Ru �$ PRQCESSGD 1N $rJSINESS DAYS `L <br />r <br />SIGNATURE [)F A PLtCANT cf ' "..,; DATE: <br />�o Ll b � 2- f'f f <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />,wl� 7B ro"u r <br />❑ fiOUSi?1G ASATEhEt:�li r L SOLID WASTE FACILITY <br />�UNDERGROUN0 TANK (UST) CLSOUP SITE (LCIPi ❑ HOUS FG AELTY C OUDINASTE VEHICLE <br />rS-.QTHER CLEANUP 617E (HON4-OP) ❑DOG KENNEL ❑ DAIRY <br />UNDERL1R4i1N0 TANK (MON iTCFiINdlREMOVAL) a CHICKEN RANCH M PKG TREATMENT PLANT <br />@3-}rAZaRDOUs WASTE dfrTtERRTt7ft LMC7TEL E3PUMPECi LAND UR TRUCK1YAP.0iCNEM T0"TS <br />Mf�TE <br />TIfR�!] pERNirTTEp fAC1LiTY SSE APPLICATION SITES <br />O MOTE <br />d TATrpalg(7DY pE]R{ INC 0 PUBLICOISPA WATER SYSTEM L3 ETHER (PLEASE SPEMFY ABCTVE) <br />1i <br />0 IDICAL WASi1a FACILITY <br />7, List ug to ten addresses in the spaca above, Select the types) of lie for from <br />09) 4_Bi4 Q13Bst yarbm to theg <br />tna appropriate box(es). At least one file typo MUST be toloeted, <br />address indicated abovead <br />2. EH7 will notify the applicant tf any EHD files exist. An appointment for roview will blies ii irm files <br />approximately ttve buslnaSs days but no later than ton (10) days after receipt of app <br />will be held for a maximum of five business days for rsvlew. Appointments should be scheduled <br />accordingty. <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 filo'sic $Vallat)IS, <br />4. Any file not returned in the same condition as released will be roorgani a $8 EG D ��ff prior t the X review. <br />of the applicant. Future file reviews by the &SITIG applicant may req <br />g, "TENTATIVE appointment datos must ba confirmed with EHO staff. <br />4. Applications received after 3:40 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DAT" CONFIRMED <br />REVIEWED <br />YPA NO <br />TIME <br />PHONE FAX <br />REVIEW DATE <br />1NFTIALS _ <br />