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12/07/20001 \ DATE NEC EUED 11:42 90527' t6 OFFICEMAX H 062' SAN JOAQUIN COUNTYPUBLIC HEALTH SEWICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (209) 4683420 PUBLIC RECORDS RELEASE APPLICATIOF'' APPLICANT F'eC+ ' -) o Xy\OOCM BUSINESSIACENCY PAGE U1 EHD LOO NUMBER �O / ADDRESS tUC�V—t:k'. V 'SIVE r—W%::. - PHONE(_ -D5 �2i�—C�3-1.7 FACSIMILE D��Z-T�---ZqS—^'—' TENTATIVE' APPOINTMENT DATE 'a -QO2 TIME ✓�'�� G'�'' - (Please give 7 to 10 business days from date of applicatlon submittal) L/NiT // `,,''�/� CHECK BOX TO EXPEDITE REQUEST -$70,00 FEE —REQUEST P OCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE ENVIRONMENTAL HEALTH DIVISION FILES /UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOU13 WASTE FACILITY OTHER CLEANUP 917E (NON -LOP) C3 FOOD FACILITY 13 SOLID O 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 209) 484-0138 or mall to the address Indicated above. 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the some applicant may require a $78.00 deposit prior to review. 5. `TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EH W 14 01MW O - --- WASTE VEHICLE UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPFR TRUCKrfAROICHEM TOLETS ❑ TATTOOIBODY PEIRCING ❑ POOLlSPA ❑ LAND USE APPLICATION SITE$ ❑ MEDICAL WASTE FACILITY U PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) O 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 209) 484-0138 or mall to the address Indicated above. 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the some applicant may require a $78.00 deposit prior to review. 5. `TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EH W 14 01MW O - ---