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06/14/2004 16:13 FAX 209 9480621 <br />=ATE RECEIVED <br />�0 SAN JOAQUIN COUNTY <br />/:. <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3'd Floor Stockton, CA 95205 <br />J U N 14 201409) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />ENVIRUNMENT HEALTH <br />APPLICANT: <br />ADDRESS: <br />PUBLIC RECORDS RELEASE APPLICATION <br />U002 <br />9a- / 3��;' FACSIMILE: / <br />TENTATIVE' APPOINTMENT DATE: G /�7/ o 3 Time:/!06 <br />(Please allow 10 business days from date of application submittal <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE– REQUEST PROCESSEDIN3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT - u�le `— DATE 611F <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />��- <br />. OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />UNDERGROUND TANK(MONITORINGIREMOVAL) <br />❑ DOC KENNEL <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELINOTEL <br />❑ TATTOO/BODY PIERCING <br />❑ POOLISPA <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPEC <br />Department Use Only <br />UNIT <br />❑ Unit 1 <br />Unit <br />❑ Unit 5 <br />r mi <br />I " Y <br />SOLID WASTE FACIL"yV' c-7 <br />PCSOLID WASTE VEHICLE <br />❑ DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ LAND USE APPLICATION SITES <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 (209) 464-0138 or mail to the <br />address indicated above. <br />2. 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 />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 $93.110 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 />DATE'CONFIR MED <br />REVIEWED YES <br />TIME <br />HONE. FAX <br />. REVIEW DATE <br />-"INf(I.ALS <br />