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2002 13:59 FAX 925 945 e485 <br />V � nzA2nn2 15:00 <br />464013a- <br />WESTON WALNUT CREEK <br />FNVIRONMENTAL Ft— .TH <br />SAN JOAQUIN COUNTYPUSLIC HEALTH SERV; <br />ENVIRONMENTAL HEALTH DIVISION <br />. r 304 EAST WEBER AVENUE, THIRD FT_OOR <br />�r '^ �� STOCKTON CA95202 <br />(209 458,420 <br />3 46LIC RECORDS RELEASE APPLiCATI <br />APPLICANT <br />ADDRESS p V /S 7.5 <br />PHONE 9O` ��� Q 7,5 <br />TENTATIVE•. AI W omTMENT DATE <br />(Please a)ve T, <br />0 CHECK box To EXPEDrlE REQUEST <br />SIGNATURE OF APPLICANT <br />IM <br />U002 <br />PACE 01 <br />"you µamu' <br />SE <br />DATE �ti� 4/Q2— <br />: <br />--�_ <br />�mT:l�snl• <br />c <br />1 0 <br />4 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />9F UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ,IR( SOLID WASTE FACILITA. <br />■ OTHER CLEANUP SITE (NON -LOP) ❑ r-0OD FACILITY ❑ SOLID WASTE VEHICL% <br />UNDERGROUND TANK (NOONMORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />9 KAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PL <br />0 TIERED PERMITTED FAcit" ❑ MOTELa40TEL ❑ PUMPER TRUCKIY AFM TOILETS <br />CI TATTOOIBODY PEIRCING ElPOOUSPA O LAND USE APPUCA Wes <br />❑ MEDICAL WASTL FACnJTY O PUBUC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the space above. Select the typos) of files from the list aboVe.by checking <br />the appropriate box(es). At least one file type MUST be selected_ Fax to (209) 464-0136_!_ mall to the <br />address Indicated above. '1 <br />2. EHD will notify the applicant if any EHD files exist An appointment for review will he oB _rued <br />approximately five business days but no later than ter+ (10) days after receipt of applicae. The files <br />will be held for a maximum of five business days for review. Appointments should be <br />duled <br />accordingly. � ,,� <br />3. A file that is actively being worked on by EHD staff may not bo immediately avallable rpf,TOView. A new <br />application may be submitted when the file is available. - -� <br />4. Any file not returned in the same condition as roleased will be reorganized by EHD st&114t the expense <br />of the applicant. Future file raviews by the same applicant may require a $69.00 deposit prior to review. <br />S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applicatlons received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED_ YES <br />I -- <br />TIME <br />PHONE FAX <br />NO REVIEW DATE <br />INITIALS <br />