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llb/. U/LUU4 11:56 r,�a zUa 94tfUbZl igjuuz <br /> rl r �n "LOG NUMBER <br /> ME <br /> oars CI�E J I <br /> 1�N JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 3 0 2004 004 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 55202 ]vt <br /> ENVIRUNI,I'D11HEALTH (209) 4013-3420 <br /> PE. Pv !T%SERViCEDBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �G\I t fj S' 1A,�,L-E"S BUSIN£SSIAGENCY 15�� <br /> ADDRESS �irUU�i .' 't ��.•� �.l <br /> PHONE 'l�{ FACSIMILE <br /> I <br /> TENTATIVE*APPOINTMENT DATE T1ME -A — <br /> j (Please give 7 to 10 business days from date of application submittal) V <br /> `J <br /> I <br /> CHECK BOX TO EXPEDITE REQUEST-;07.00 REQUEST'RAZOGFSSED IN 3 BUSINESS DAYS <br /> AS GNATURE OF APPLICANT PATE a <br /> FILE ADDRESS THIS SIDE EH.D STAFF USE ONLY <br /> pROGRAM ELEMENTS SEARCH <br /> j V< t � It ( t� • � , -- <br /> N o �1� q 0 w .P«- va1wo �� , <br /> (� P, \ �U Y• i t - k c t •l <br /> ` \ Y� to Lt L, <br /> i - <br /> 100, <br /> I <br /> - V <br /> ENVIRONMENTAL HEALTH D11(iSION FILES ~-7 ;O <br /> 4l SOLID WASTE FACI <br /> d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE VEHICLE • <br /> 19, OTHER CLEANUP SITE(NON-I-OP) . ❑ FOOD FACILITY III <br /> gi UNDERGROUND TANK.(MON ITORINGIREMOVAL) Q DOG KENNEL g DAIRY <br /> ❑ CHiGKEN RANCH �'PKG TR>=ATMENTP S <br /> l HAZ.AROQUS WASTE GENERATOR 0 CHIC r-N RANTEL ❑ PUMPER TRUQYJYARDIC S. <br /> 0,, TIFRED PERMITTED FACILITY Fa* AND USE APPLICATION SITES <br /> O TATTOCYBODY PEIRCING ❑-POOLisPA p OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY p PUSUC WATER SYSTEM <br /> 1 Ust 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 46440138 of mail to he <br /> address indicated above.. <br /> r; „ „ .,c• �:_ :c c un .� vtef A,r!2rnrnninLrnent for review will be Confirmed <br /> 21 )nna will notify-the apF,l' a"�t" --, E� D E...�•. days after receipt of application. The files <br /> approximately five business days but no later than ten(10) y. Appointments should be scheduled <br /> will be held for a maximum of five business days for review <br /> accordingly. <br /> 31 A file that is actively being worked on by EMD staff-may not be immediately available for review. A nev <br /> application may be submitted when the file Is available, <br /> 4+. Any file not returned In the Same condition as releasedwilltbea-r eer ani uire a�,by E O Staff prior to re iev <br /> at the expenSE <br /> of the applicant Future file reviews by thb 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 PAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />