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02/03/2004 13:11 FAX 209 9490621 - IA002/002 <br /> DATE REGENEo I.. :- EM Loc NUMBER <br /> �� IIo �i SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> EAST WEBER AVENUE,THIRD FLOOR <br /> FEB 0 3 2004 ' 304 STOCKTON CA 95202 <br /> ENVIRONMENT HEN'1H (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APFUCANT_ _ t-L'J03 _ �IfiQy,�jS 6USINESWAGENCY kl...�./.�.1 <br /> ADDRESS ?.�25 F M`NLi'LE- C— STO ceht�rJ Ck <br /> PHONE -1_ qt?`! FACSIMILE qL(UG06 <br /> q <br /> TENTATIVE'APPOINTMENT DATE Z�13 f O E'l' TIME <br /> on <br /> (Please plus 7 to 10 huslness days from data o(appilcallsuhmWal) �.. <br /> 17 CHECK BOX TU-ECPFDFrE REQUEST-587.00 -REQUE T OC£SSED IN 7 9USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> I' PROGRAM ELEMENTS SEARCH <br /> I, <br /> i' <br /> FF9774 ' <br /> ENVIRONMENTAL Hi=ALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(USTI CLEANUP SITE(LOP) 0 HOUSING A13ATEMENT - W SOLID WASTE FACILITY <br /> Q} OTHER CLEANUP!SETE(NON-.OP) ❑ FOOD FACILITY Cl SOLID WASTE VEFiICLE <br /> Ol UNDERGROUND TANK(MONITORINGIREMOYAL) ❑ DOG KENNEL ® DAIRY <br /> tP HA7AR000S WASTE GENERATOR 0 CHICKEN RANCH F PKG TREATMENT PLANT <br /> 173TIMM PERMITTED FACILITY � ❑ MOTELIHOTEL � 0 PUMPER TRUCKfYARDICHEMTOILETS <br /> ❑ TATTOOIBODY P61RCING 0 pDOtisPA - - � 1$ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE kAC1UTY 14 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type($) 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 mall to the <br /> addresslIndicated 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 field 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 /> applicAon may be submitted when the file is available. <br /> 4. Any file�hot 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$87.00 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 /> f <br /> CONFIRMED �POINTMENT DATE TIME,, <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> 4. <br /> REVIEWED YES bin Prmpw nATP <br />