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07/17/03 10:18 FAX214 630 7070 HBC ENGINEERING <br /> _ — <br /> oAt RadmwI0 I 1 I I ERo LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEN' 2 <br /> _�U L L 7 '('003 304 EAST WEBER AVENUE,THIRDD FLOOR ` <br /> J <br /> STOCKTON CA 95202 <br /> d1V1 II ' r cN�IH (209)468-3420 <br /> n,,, r .,��`;VCiPUBLIC RECORDS RELEASEE APPLIICDA�T�IO�N <br /> APPLICANT <br /> (^�&wa-U/CC�{' L&y BUSIIN£SSIAGENCY <br /> ADDRESSr7 ICI -1-fY- z-fJ`71`� FY^u�" i' �( (EJC> 'JrIL_L_F1 J r31L <br /> PHONE C2 19 orb— (C> -_ - FACSIMILE' C2 17 <br /> TENTATIVE'APPOINTMENT DATE f1al D3 TIME <br /> r\�/7 (Please give 7 to 10 business days fnoit dake of application submittal) 1\ U <br /> 4i+ CHECK BOX TO EXPEDITE REQU.,/T-$89.00 FEE-REOUES PROCESSED IN 313USINESS DAYS <br /> _ u n ` <br /> SIGNATURE OF APPLICANT � DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY (\. <br /> PROGRAM ELEMENTS SEARCH <br /> 2b �It�l PGQ-$�'1IN�C _ r�_ .7 .•'Lu�4 I <br /> vv�f <br /> lilt Npw y N--w G <br /> �II-1-ii-10 V( <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) t] FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 11 MOTELIHOTEL In PUMPER TRUCKIYARDICHEM TOILETS <br /> 11 TATTOOIBODY FORCING O PGOL/SPA 0 LAND USE APPLICATION$ITE3 <br /> ❑ 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 by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> addressindicated 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 held for a maximum of rive 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 /> 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 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 /> ENO 18L].OM. <br /> y=6�SEOE <br />