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10002/uu2 <br /> 05/•07/2003 06:50 FAX 209 9480621 <br /> � ENo BOG N�WBER <br /> O M RECMY <br /> iF-= -',, SAN JOAQUIN COUNTYPUBLIC HEALTH SERVIG <br /> ENVIRONMENTAL HEALTH DIVISION I <br /> 304 EAST W EB MAY AVENUE THIRD FLOOR 0 7 2003 STOCKTON 95202 <br /> (209)466--3420 107 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> rC <br /> APPUCANT 16�V L'lS\�e�k S BUSINESSIAGENCY <br /> ADDRESS n _I E7- �K iL-�. <br /> FACSIMILE 209- 946 nA <br /> Z! <br /> PHONEl �I - -- - <br /> S�( �03 TIME •'- <br /> TENTATIVE'APPOINTMENT DATE 0ntlon subml <br /> (Please glome 7 to 10 tTuslrtess days ko^�data of apptta) <br /> CHECK BO%70 EXPEDRE REQUEST- .00 -REQUEST P SED IN 9 BUSINESS DAYS ' f �' <br /> DAT; <br /> SIGNATURE OF APPLICANT - <br /> FIIF.ADDRESS _• THIS SIDE:EI-ID STAFF USE ONLY r <br /> PROGRAM rLEMENTS SEARCH <br /> STD I 0 D <br /> I <br /> 4 <br /> 0 <br /> 7.0 ,s - 3 v Ary I rw E t' O <br /> k O <br /> 2Gro �• FYF� J ET S <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT In SOLID WASTE FACILITY <br /> PL UNDERGROUND TANK(UST)CLEANUP SRE(LOP) U FOOD FAMLITY El SOIJO WAS rE VEHICLE <br /> PL OTHER CLEANUP SITE(NON�.OP) U DOG KENNEL Sl DARY <br /> IR,UNDERGROUND TANK(MONIT ORINGIREMOVAL) 0 CHICiC:.N RANCH M PKI3 TREATMEErr PLANT <br /> HAZARDOUS WASTE GENERATOR p CHIMH RANTEL O PU�IEPERTpUCK1ARD/CEEEIIITOILETS <br /> TIERED PERMnTED FACn_ITY q.POTIUJHO .ID USE APPLICATION SITES <br /> O TATTOOIBODY PEIRCENG PUBLIC YEATER SYSTEM ❑ Op1El;(PLII.SE SPECIFY AriOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses In the space above. Select the type($)of files from th"list above by checking <br /> the appropriate box(es), At least one file type MUST be selected. Fad!x!09 364-038 or mail t0 the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any <br /> y EHD files exist An appoinlm anerorrf e f eY o�al be confirtni files <br /> approximately five business days but no later than ten(10)days iter rFsnts sh f apDulplication. <br /> scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately avallable for review. A new <br /> application may be submitted when the file Is available. <br /> 4 Any hele not returned In theapplicant. Future fl esame reviews by the samecondition as applicant may require eased will be a 587YG dDepo It prior t expense <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO 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 FAX INITIALS <br /> ,r,;'v�rea�c�irP�sts 5�aivi, P(clC�Iejjn `, Ilsgq m <br /> !j <br /> oevEeu�n vec <br /> 5-jb 3.1�IdCtMn l w l �",OdUM5-i0•.s944j <br />