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rrn:n'I : NOR Enviroranental PHONE NO. : 209 369 4228 Dec. 03 2002 02:54PM P2 <br /> uA1EHECENE6_ Eno IOC HUMBER <br /> nlc, l ,I' JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION ' ��� <br /> v 304 EAST WEBER AVENUE,THIRD FLOOR <br /> DEC 0 3 2002 ' <br /> STOCKTON CA 95202 <br /> :jA/ `-?fIWENT I I[ALTH (209)466.3420 <br /> FF An.11T/SFR,vjICl�FUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTfTBI`3T� C 1 F'r1C-•Cw-14 BUSINESS/AGENCY 46k E•NJtR0r-jMCfJTAL_ <br /> ADDRESS ZZ- RTD UV 'v LANE 1'0-tI,I <br /> PHONE (Zbl) '- yt�2C� FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME )0%60 QYN <br /> (Please give 7 to 10 business days from date of appllcation submittal <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 UNG JAYS )' <br /> SIGNATURE OF APPLICANT DATE f Z-3-OZ <br /> FILE ADDRESSCfriZ� THIS SIDE EHD STAFF USE ONLY <br /> (-Od PROGRAM ELEMENTS SEARCH <br /> 1 29 /J•Gvi J Ave- I 12-55fy N. Cry ld . <br /> v� 1 cmae 1J <br /> t <br /> v g iG �1vvw - <br /> V� Ir <br /> SI• <br /> 133 E. -'rV✓VLkAv led- <br /> ENVIRONMENTAL HEALTH DIVISION FILES V�Lu S L Yev 6hVS <br /> 9t UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> $I OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> Z UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNET ❑ DAIRY - <br /> N HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> '% TIEREo PERMITTED FACILITY 0 MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ PGOL/SPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY „ 0 PUBLIC WATER SYSTEM 1)4 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 box("). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 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 END staff may not be immediately available for review. A new <br /> application may be submitted when the filo 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 $89.00 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 />