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LHU LOU 3 <br /> SAN JOAN COUNTYPUBLIC HEALTH SE�CES <br /> E ONMENTAL HEALTH DIVISION , 3 9 <br /> 304 EAST WEBER AVENUE, THIRD FLOOR C� <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> a PUBLIC RECORDS RELEASE /APPLICATION e I <br /> APPLICANT��-tl// - BUSINESS/AGENCY 22C <br /> ADDRESS �S_n A) <br /> PHONEj( O '"�(�� FACSIMILE l// • <br /> TENTATIVE"APPOINTMENT DATE TIME 2000 <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST�$3& 0 FEE REQU PROCESS IN 3 BUSINESS DAYS /l <br /> SIGNATURE OF APPLICANT DATE <br /> Q <br /> FILE ADDRESS t <br /> rOr , ` <br /> W <br /> cK ro <br /> 8iuLu"L�& U & <br /> D <br /> ENVIRONMENTAL HEALTH DIVISION FILES FEB 18 2000 <br /> .UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> iZ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> X UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> kd HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM OTHER(PLEASE SPECIFY ABOVE) <br /> :5GPT1C- <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. 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 ten (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 /> 3. A file that is actively being worked on by EHD 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 same applicant may require a $78.00 deposit prior to review. <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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01/05100 <br />