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U6,UII/2005 15:99 FAX 209 9480P <br />Ifl002/OOT <br />PATE RECEIVED cnL. �....:.,.,...�., <br />SAN JOAQUIN COUNTY <br />ENYMONMENTA.L HEALTH DEPARTIATNT <br />304 E Weber Ave 3 e Floor Stockton, CA 95205 I 7o' ZRE 9� 68 "3420 Fax: (209) 464-0138 Web:www.co.sanjoagllin.caus/ehd <br />ON t u 700 UgLIC RECORDS RELEASE APPLICATION <br />NT <br />HE' (H BUSINESSIAGENCY: ^ e ) <br />APPLICAlA".`��*��� <br />M <br />ADDRESS - <br />PHONE: FACSIMILE.: (' <br />TENTATIVE' APPOINTMENT Dare: TIS= <br />(Plwse allow 10 busines9 days from date of applicatian submitbll) <br />0 CHECK BOX YO EXPEDITE REQUEST - 597.04 FEE - REQUEST PROCESSED IN a BUSINESS DAYS <br />DATE , 00 sc—, <br />Department Usa Only <br />SIGNATURE OF <br />4')-W <br />2415 <br />2448 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />❑ Unit 1 <br />Unit 2 <br />Unit 3 <br />Unit 4 <br />❑ Unit 5' <br />nlfi( <br />��O <br />0 <br />1p <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT uL sono WASTE PACIUTy <br />OTHER CLE4NUP SITE (NON -LOP) O FOOD FACILrr( ❑ SOLID WASTE VEHICLE <br />18� UNDERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL EL DAIRY <br />in HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IB-PKG TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS O <br />Q TArrociaoDY PIERCING ❑ PooLISPA M LAND USE APPLICATION 51TES <br />Q MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY] <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above ay eheckmS _ <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091 464-0address138 or mail to the <br />EHO will notify the <br />above. <br />2, EHD will notify the applicant if any EHD files exist An appointment for review will he confirmed <br />approximately five business days but no later than ten (10) days after receipt of applicatton. 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 an by EHD staff may not be immediately available for review, A ne <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 expert: <br />of the applicant, Future file reviews by the Zama applicant may require a $93.00 deposit prior to revu <br />5, . 'TENTATIVE, appointment dates must be confirmed with EHD staff. <br />S. Appticatioris received after 3:00 pm wilt be processed the next business day. <br />----------------------------------- <br />).r' .,Y IME ':.1:1 Hf •� •. <br />rREVIEWED <br />AP.;POINTMENS-[]P.7E 'P :�.fti ':>.:: % :j FYES NO' REVIEW DATE ' <br />