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. 09/83/204'4, !1 �$ 209-579-222'5 MODESTC] ATC PAGE 01 <br /> r!(�7�RHC 16KR0 I o 1 I r k <br /> EHU LOl7 NUMBER <br /> SAN JOAQUIN COUNTY 40 <br /> SEP o 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> -;J'Jii:UhitEN j HEALTF ST (209) <br /> CA 95202 <br /> PF,T-) !T+SERV CES {zo9) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATI©N <br /> APPLICANT -t at✓` SUSINESSIAGENCY AA `15J•� <br /> ADDRESS e Alzll k� <br /> PHONE �2� _ _ FACSIMILE J� --z-,ui-S— <br /> TENTATIVE`APPOINTMENT'DATE_ 'A(1 �'Ql 3 TIME 04 C� <br /> (Pleas@ give 7 to 10 business days from data of application aubmlttai) • \ <br /> CHECK BOX TO EXPEDITE REQUEST-;$9.p01FE-REQUEST PROCESSED IN 3 8US1N£95 GAYS Ir I(I <br /> _ I <br /> SIGNATURE OF APPLICANT b)L " v DATE `t[-' �3 _ <br /> FILE ADDRESS <br /> THIS SIDE F-HD STAFF USE ONLY'• C> <br /> PROGRAM ELEMENTS SEARCH <br /> O }' <br /> rip <br /> T~voM J <br /> Lk— <br /> 1 � � Ufa 54•a�,�a-o-, <br /> SOL <br /> .u`�l A?a� f�.;� S � 141 •,r-, <br /> �>�VI�RONM`ENTAL HEALTH DIVISION FILE <br /> V UNDERGROUND TANK ft)"CLEANUP SITE(LOP) © HOUSING ABATEMENT C3 SOLID WASTE FACILITY <br /> Q OTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORfNGIREMOVAL) ❑ DOG KENNEL © DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK,YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PI IRCING © POOVSPA ❑ LAND USE APPLICATION BITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1, List up to ten addresses In the space above. Select the type(s) of files frorn the lint above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax t4 (209) 464-0138 or__W11 to the <br /> addret§ Indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for revlew will be confirmed <br /> approxlmataly five business days but no later than ten (10) days after receipt of application. The files <br /> wlii be held for a maximum of five business days for revlew. Appolntrnanta should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EMD 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 sante applicant may require a $39.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Appiicatlons received after 3:00 pm will be processed the next business day. <br /> DATE 012INFIRMED PHON,E. :-:� . .. ..- #NIVALS <br /> RE:VIf-YVEF YES /NO 6 Vf 1 ,0At 1; <br /> EH046-0240E <br /> .���" <br /> a�axoo� • `J, �. e �i. I Cl C" 1`t�` C(-�( C: • /'�{C( r i til/tel <br />