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OT/32/2002 10: 22 FAX 209 948 OF21 KLEINFELDER Q)002/002 <br /> .- rryO L+NU� <br /> so <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ,-/,p DuSINESS/AOENGY <br /> ADDRESSHEALTH <br /> PHONE <br /> cTyB— /3y� FACSIMILE <br /> I <br /> 7/aq/O�— TIME <br /> TENTATIVE*APPOINTMENT DATE f appl tion submittal) <br /> (Pie a57 t°��busin2 days tj�l Ea�fj�Q <br /> CHECK BOX TO EXPEDITE REQUEST• 7.00 FEE-REQUEST PR OL SSE N 3 S[NESS AYS <br /> DATE iY•7 <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIDE EBB STAFF U ONLY <br /> PROGRAM ELEMENTS C <br /> �i oLUoZO Al Cc l: ern:n ( IOCCc�o t Cfk <br /> a IS C� I;Forn:q t +o� [A <br /> _ 1 <br /> Ltl <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT .�SOLOD WASTE FAI:ILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING <br /> NG AB IY SOLID WASTE VE�IICL-E <br /> ,,0_OTHER CLEANUP SITE(NON-LOP) ❑ DOG <br /> KENNELFACILITY <br /> ❑ DAIRY i <br /> )a'UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH C1 PKG TREATMENT PLANT <br /> )a'Hg7_ARDOUS WASTE GENERATOR ❑ CHICKEN RANTEL ❑ PUMPERYRUCK&ARDICHEM TOILETS <br /> ,e TIERED PERMITTED FACILITY .PpO�PA ❑ LAND USE APPLICATION SITES <br /> ❑��yTATTOOISODYPEIRCING ❑E3 PUBLICWATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVE) <br /> ,C+ MEDICAL WASTE FACILITY <br /> 1_ List up to ten addresses in the space above. select <br /> l ct the type(f f FaxS from <br /> o20th46�t+138vor ma e by checking <br /> eg <br /> the appropriate box(es). At least one file type <br /> ` ect <br /> addresslPdicatedabove. HD files exist. An view wl e confirmed <br /> 2 approxim teEHD will notlly fy five businthe ess days but no later than en(10) days afterreointment frceipt ont it any Ef aP licat on. The files <br /> will be held for a maximum of five business days for review. Appointments shouldlIbe scheduled <br /> accordingly. IIe for review. Anew <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately avallaf!l <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 EHDj staff at the ee w <br /> of the appilcanL Future file reviews by the same applicant may require a$87.00 diposit prior <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 /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS — <br /> REVIEWED YES NO REVIEW DATE A <br />