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ntS/,.u/LUU4 11:0?3 rAA ZUa aa46UUZI Ly-jvuZ <br /> LOG NUMBER <br /> DATE REGN \,'�tIL <br /> `J�— ' J N JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> i ENVIRONMENTAL HEALTH DIVISION <br /> JUN 3 0 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA B5202 ]v� <br /> Ei VIRONNIcill- HEALTH (209) 460-3420 <br /> PcRfrllT/SER�JiCENBLIC RECORDS RELEASE APPLICATION <br /> i <br /> =A- UCANT E-� - J 1. 91 L-f--S BUSINESSIAGENCY �- ¢fi �� <br /> ADDRESS Cii ` � .' 1.1v1�� <br /> G K FACSIMILE <br /> PHONE ~ <br /> TENTATIVE'APPOINTMENT DATE I TIME - <br /> '� (Please give 7 to 10 business days from data of applirytlon submittal) <br /> i <br /> CHECK BOX TO EXPEDITE REQUEST-58T,00 F —REQUEST OCESSED IN 3 BUSINESS DAYS <br /> DATE a <br /> S GNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH f <br /> � i✓ �J I i <br /> NG 5 q W 1 — ��►-P c Ro It <br /> \�� �U Y� l L k c l •f <br /> 4�v - sL& 4 <br /> i <br /> ENVIRONMENTAL HEALTH DMSION FILES <br /> M SOLID WASTE FACIZ, <br /> d <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) o FOOdIFAC11 IT1(�Ml=NT ❑ SOLID WASTE VEHICLE • <br /> �4 OTHER CLEANUP SITE(NON-LOP) CI DOG KENNEL 119 DAIRY <br /> 1j1 UNDERGROUND TANK,(MON ITORINGIREMOVAL) 0 DOG KEN RANCH M PKG TREATMENT <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKMOTEEN <br /> RAN ❑ PUMPER TRUCMARDIC <br /> a TIERED PERMITTED FACILITY 0 POOLISPA LAND USE APPLICATION SITES <br /> O TATTOOIBODY PEIRCING p puaUC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY <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 o 209 464&J38 or mail to he <br /> Address indlcafed above. . <br /> ppli any EHD fii� ex!-t- F�2pp^in+r.�ent for review will be confirmed, <br /> LIll7 win, nOuiy tI�IG'a i�i.a�t�l� a�� <br /> i <br /> approximately five business days but no later than ten(10) days aQintments shou dpbe scheduledles <br /> will be held for a maximum of five business days for review. App <br /> ! accordingly. <br /> 31. A file that is actively being worked on by EHD staff,may not be immediately available for review. A rtev <br /> application may be submitted when the file is available, at the ensE <br /> 44 Any file not returned In the same condition as releas cant Mayill be <br /> requireq �a$87.00 deposed by EHD it prior o eviev+ <br /> of the applicant Future flie reviews by the same app y <br /> '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 />