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11 1,o/IrJ LL f/ 411U W t.Ne(dLLI: <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> MAR 2 1 2001 ENVIRONMENTAL HEALTH DIVISION 1 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR J`�.�C, V`��✓JJ <br /> ENVIRONIVIEN I HEALTH STOCKTON CA 95202 <br /> PFRf,d1!T/°r ES (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> UPS I �h 8US1NES5lAGENCY 00I(/ U <br /> RESS j <br /> v J O,S'b l7 � ., �*,1•. rJ�f' Sp h- <br /> PHONE �I aJ 3 �d1--- T 3 FACSIMILE I /-�7�` / 0 bS <br /> TE#TATIVE"APPOINTMENT DATE �`a /—O 1 TIME q!-3C <br /> '' (Please give 7 to 50 business days from date or application submittal) 11 A p i <br /> CHECK 4P C TO E%PED9F REQUEST-$ T 0 FEE- QUEST PROCESSED IN 3 BUSINESS DAYS ryI~11 <br /> SIGNATURE OF APPLICANT � � DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY v <br /> PROGRAM ELEMENTS SEARCH r <br /> aLO <br /> 2-q I DID L rA J o — Trq r E <br /> f O e ew Dh rte <br /> D rol <br /> [ D <br /> 16 . <br /> mAR 12 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ), UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ ROUSING ABATEMENT M SOLID WASTE FACILITY <br /> ;q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOGKENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO(BODY PEIRCING ❑ POOL/SPA "-` ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 bDx(eS). At least one file type MUST be Selected. Fax to (209)464-0138 or mai(to the <br /> address indicated above. <br /> 2.1 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 he 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 maybe submitted when the file Is available: <br /> 4. Any file not returned In the same condition as released will be reorganized by Elio staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $117.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must he confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next huslness day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRNIED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 9H ca a .0W7= — <br /> 3001A I9RN-DDUTTVA 9906 7.LE 9[6 YV!T T£:LO TO/TZ/CO <br />