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UUZ <br />11n/,:U/ZUU4 11:55 YAA ZUa U46UUZI <br />`1 <br />ED F_ (' �i R��� Exo roc NUMBER <br />JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />JUN 3 O 2004 304 EAST WEBER AVENUE, THIRD FLOOR .. <br />STOCKTON CA 85202 <br />ffiMRUN%'1'hJ1 HENLTH (209) 468-3420 <br />PERPIIT;SERV10ENBLIC RECORDS RELEASE APPLICATION <br />�GJ t fj g jPk,L. •S BUSINESSIAGENCY <br />— 1 <br />.cam G' <br />IE 41 lj �k5 FACSIMILE �� ~ <br />TENTATIVE' APPOINTMENT DATE I t O I O N — TIME <br />(Please give T to 10 buslness days from date of DPOCallon submittal) l <br />CHECK BOXTO EXPEDITE REQUEST -30700 F – REQUEST OCESSED IN 313USINESS DAYS O <br />PATE <br />4ATURE OF APPLICANT <br />Np q <br />Nc q�� <br />PROGRAM ELEMENTS SEARCH <br />,l k <br />-7 DIT• _. S <br />ENVIRONMENTAL HEALTH DIVISION FILES -71911 q S <br />d, UNDERGROUND TANK(UST) CLEANUP SITE (LOP) <br />t7 HOUSING ABATEMENT <br />M SOLID WASTE FACILITL� jy❑ SOLID WASTE VEHICLE • <br />OTHER CLEANUP SITE (NON -LOP) <br />qi UNDERGROUND TANK,(MONRORINGIREMOVAL) <br />O FOOD FACILITY <br />O DOG KENNEL <br />� DAIRY <br />Cr PKG TREATMENTP <br />0 HAZARDOUS WASTE GENERATOR <br />C7 TIERED PERMITTED FACILITY <br />0 CHICKEN RANCH <br />.❑ PUMPER TRUCKlYARDlC <br />P LAND USEAPPLICAIION SITES <br />O TATTOOIBODY PEIRCING <br />PdOUSHOTEL,. <br />P'POOLISPA <br />Iw PUBLIC wATER SYSTEM <br />O OTHER (PLEASE SPECIFY ABOVE) <br />P MEDICAL WASTE FACILITY <br />(s) <br />of files from the list above by checking <br />1 List up to ten addresses in the space above, Select the type <br />the appropriate box(es). At least one file type MUST be selected_ Fax to 209 464 38 or mail to 1he <br />address indicated above.. I „ ;nLment for review will he confirmed. <br />21 EHD will not{fy the applicant I, any <br />-HD files eX,st. An 2p -•• <br />approximately five business days but no later than ten (10) days after receipt o ld be scheduled The files <br />I <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 on by EHD staff may not be immediately available for review. Anev <br />application may be submitted when the file is available,at the <br />4f Any file not returned In the same condition as released ant mayill be requirerani a d by EHD <br />deposit prior to r iev <br />ensE <br />of the applicant. Future file reviews by the same app Y <br />'TENTATIVE appointment dates must be confirmed with EHD staff. <br />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 />REVIEWEp YES NO REVIEW DATE <br />