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_ H�/�/ _ P-02 <br />Fe -14-02 12:0_ 1P Hers_t Associlt.Ps; Inc��vr bw3i6 r! �IPACE 01 <br />a^TG stcwePfen `OC MA4M <br />JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />7/ <br />304 EAST WEBER AVENUE. THIRD FLOOR <br />STOCKTON CA 95202 <br />(,209)468-3420 7 <br />02 FEB 14 Ali 10: 20 PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS <br />PHONE <br />FACSIMILE <br />TENTATIVE' APPOINTMENT DATE TIME <br />(Plea Se pive7t410Quslneaz drys e'en ite of J.atior <br />0 CHECK BOX TO EXPEDITE REQUEST <br />SIGNATURE OF APPLICANT <br />DATE <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />R'OTHER CLEANUP SITE (NON4.OP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />m'yNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />R'JINARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />gy TIERED PERMITTED FACILITY <br />❑ MOTELMOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOOBODYPEIRCING <br />❑ POOVSPA <br />❑ LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILRY <br />❑ PUBLIC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <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 it 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 tiles <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 589,00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications recelved after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />TIME <br />PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />