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"-,1 04/21/2003 07:30 FAX 209 948062fe QI002.•002 <br /> Em log mmom <br /> oarF �n�:°�����'�\Q���D�SAN JOAQUIN COUNfYPUBLIC HEALTH SERVICES <br /> �� ` "i- `' J ENVIRONMENTAL HEALTH DIVISION r <br /> 2��3 304 EAST WEBER AVENUE,THIRD FLOOR I -J✓^� <br /> APR 2. 1 STOCKTON CA 95202 <br /> i3uVli;Urd /EL PUBLIC RE (209)468.3420 CORDS RELEASE APPLICATIOaN <br /> GFRs �T SEE RVICEICES —_" <br /> �6��P /✓1d� 9%✓G`� BUSINESSIAGENCY h� / <br /> APPLICANT <br /> ADDRESS <br /> PHONE !c74,4— 1FACSIMILE 9 qg <br /> TENTATIVE'APPOINTMENT DATE 3 TIME 1 <br /> (Please give T to 10 business days from date of Opplica9or+submitlar) <br /> CHECK BOX TO EXPEDITE REQUEST-387.00 FEE— QUFST PROCESSED IN 7 BUST <br /> SIGNATURE OF APPLICANT DATE <br /> THIS SDEIE HD STAFF USE ONLY <br /> FILE ADDRESS <br /> PROGRJIM ELEMENENTS SEARCH <br /> J �} ArcL, Poe.dY---- <br /> r, 7Gso ewc � 2oe.d stw'�ti <br /> - N <br /> LA <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT <br /> 501.1.)WASTE FACILITY <br /> ❑ FOOD FACILITY P SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP} DAIRY <br /> 4UNDERGROUND TANK(MONTTORINGIREMOVAL) 0 DOG NN KEN CH O PI(G TREATMENT PLANT <br /> $ HAZARDOUS WASTE GENERATOR MOTEUHOTEL ., d PUMAER TRUCKryARDICHE:M TOILETS <br /> ' TIERED PERMITTED FACILITY L1O POOUSPA 12"LWI:I USE APPUCATTON SITES <br /> ❑ TATTOOIBODY PEIRCINGPUBLIC WATER SYSTEM l7 OTHIi:R(PLEASE SPECIFY ABOVE) <br /> MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of files frurn the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. FaX to.209LE',-)138 or mail toth3_ <br /> address indicated above. ointment foz review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist An apples <br /> approximately five business days but no later than ten(10)days after <br /> re elpt should scheduled f11 <br /> will be held for a maximum of five business days for review. APP <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immedtati ly 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 reorgardzed by EIiD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 61 Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INTIPd 5 <br /> REVIfiwED YES NO REVIEW DATC , _ <br />