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03/16/2007 09:34 <br />CCC V D <br />11 AR 1 6 2007 <br />ENVIRONNIIc.N T HEAL(h <br />PER("v`MSERViCES <br />APPLICANT c�0.S6ti <br />ADDRESSt` <br />9 -HONE <br />20983506 2098350675 • <br />SAN JOAQUIN COUNTYPUSL.IC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 65202 <br />(209)488-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />PAGE 01 <br />2q22� <br />TENTATIVE'APPOWTMIEN713ATE TIME <br />(PL041c4 glp0 7 to i0 b0;nc53 days barn4 data of upplIcation suhm!ttaq <br />r' CHECK BOX TO EXPEDITE F=UtST11. 278.00 FEE -. UPST PROCESSED IN 3 BUSINESS DAYS <br />-SIGNATURE OF APPLICANTE�S4-4 " 3:ii .eJt DATE � lzw)7 <br />FILL'ADDRESS <br />0. t <br />r ( <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />`"`A) UHDERGROUND TANK!UST) CLEANUP SITE (LOP) O HCUSING ABATEMENT C SOLID WAST'c FACt- <br />1{7 OTHER CLEANUP -SITE (NOWLOP) C) FOOD FACILITY CI SCUD WASTE VFJII E <br />``H UNDERGROUND TANK (MONrtoRINGrREMOVAL) U 0010 KENNEL O DAIRY <br />C3 ' <br />HAZARDOUS WASTE OENEMTOR b CHICKEN RANo CH PKG TREATMENT P_n T <br />a TIERED PFxxirrTED FACILITY - G MJ1ELINOTEL ❑ PUMPER TRUCKrYAR01CHEN TOILETS <br />Cl TATTOO=OYPEIRCLNG O POOLISPA ❑ LAND USE APPLICATION SrrES <br />MEDICAL WASTE FACILITY O PU9LIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) <br />t. List up to ten addresses in the space above. Select the typs(z) of files from the list above by checking <br />the appropriate bOX(es). At least one file typo MUST be Selected. Fax tos209t464-0138 er mzil to the <br />address in d a <br />2END will notify the applIc <br />ant if any EHD files exist An appointment for review will be confirmed <br />approximately five business days but no later than ten (117) days after receipt of application. The files <br />will bo hold for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3- A filo that Ie actively boing worked on by EHD staff may not be Immediately availab)c forreview. A new <br />application may be submitted when the f!• is available. <br />4. Any file not returned in the so.me condition as released will be reorganized by EHD staff at the expanse <br />of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br />51 `TENTATIVE appointment dates must bo confirmed with EHD staff. <br />6. Applications received after 3:00 pm Will be processed the next busiross day, <br />CONFIRMED APPOINTMENT DATE TIME ! <br />I <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />4w u o o" <br />T17TAL P.92 <br />