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08-14-2000 10:29RM 926 <br /> I TO � 1558'7126 P.01 <br /> 6ATC MC�fty�,�� `w E141 WG.UWCR <br /> \cal SAN JOAQUIN COUNTYPUgLIC HEALTH SERVICES <br /> 1u 2u v ENVIRONMENTAL HEALTH DIVISION <br /> 3G4 EAST WEBER AVENUE,THIRD FLOOR <br /> AU 1 4 Zppp STOCKTON CA 95202 <br /> (209)468-3420 <br /> ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ENI T7I ! <br /> PEF LICANT X74 t1 ILC aUSWCSWAGENCY� <br /> ADDRESS c l p�Ct��J- » 1 �'OSnn q(� A C ?! �.1 <br /> VHONE :5�5 1 , � (J JQZ.I FACSIMILE <br /> ( TENTATIVE'APPOINTmr NT DATE boy oriTIME iQ. �fm <br /> nyJ— (Plena give 7 to 10 tial a dArs from date 0f Applic4um auhrnitlal) <br /> � V ; <br /> \ Q CHECK BOX TO EXPEOIT"E REQUEST-U7�.0000 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATUREOFAPPLICANT -/ - DATE ` jkiAIck <br /> FILE ADDRESS THIS 5106 END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> b 2_ 5C) 30 kk <br /> C�4 2 I Z ,r0 a o 5. C PJ d s n - t. '-� <br /> MSR. C 5. i 0 ' <br /> -- N• =-�8o C'nnt-o 1 1 <br /> I <br /> t.�� I ��,-I <br /> �J I , I �1— -)- L I ENVIRONMENTAL HEALTH DrASION FILES <br /> Z£ UNDERGROUND TANK(UST)CLEANUP SrrG(LOP) 13 HOUSING ABATEMENT D SOLD WASTE FAGAM <br /> OTHER CLEANUP SITE(NON4-OP) Q FOOD FACnM - 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(NONITORINGIRPMOVAL) ❑ DOG KENNEL Q DAIRY <br /> ;k RAZARoQUS WASTE GENERATOR ID ID IN CHICK RAN H O PUMPER T"AMENKITPLANT EMT00.ET8 <br /> P TIERED PERMITTED FACILITY - <br /> 0 TATTODISODY PFIRCING D FoOMPA D LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q DTHER(PLEASE SPECIFTABOVE) <br /> 1 <br /> �. List up to tan addresses In the space above. SeleCt the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0130 or mall to the <br /> address Indicated above- <br /> p, EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tan (10)days after receipt of application. The files <br /> will be held for a maximum of Five business days for review. Appointments Should be scheduled <br /> accordingly. <br /> a, A file that is actively being worked on by EHD SUf1 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 conditlan as roleased will be reorganlxad by EHD staff at the expense <br /> of tho applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must be Confirmed with EHO staff. <br /> Applications received afbor 3:00 pm will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONE FAX INITIALS <br /> s <br /> REVIEWED YES NO REVIEW DATE <br /> oe 14 MUM <br /> TOTPL P.01 <br />