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09/17/2003 09:37 FAX 209 9480821 003/004 LOG HUMOrR In1SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES 2003 ENVIRONMENTAL HEALTH DIVISION SEP 17 304 FAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 lwq5I ENp RO,IiT/ NI 'ICES H (209) 468-3420 oFRnaIT�SERVICEs PUBLIC RECORDS RELEASE APPLICATION APPLICANT V— . 1 L� �W L)L3 BUSINESSIAGENCY � ?-� ADDRESS /`71- P'M"IIn PHONE 70�?lq r0-17 �t� /FACSIMILE 2-0�'�yJ/rp �2'I TENTATIVE' APPOINTMENT DATE ! I Z� �O TIME (Please plve 7 to 10 6 Ines days km date of app9cation submittal) r 1 CHECK BOX TO EXPEDITE REQUEST -$87.00 FEE— QUEST PROCESS" 0 BUSINESS DAYS SIGNATURE OF APPLICANT DATE 1_ List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above - 2.. 2. EHD will notify the applicant if any EHD files exisL An appointment for review will be confirmed. approximately five business days but no later than ten (10) days after receipt of. application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $BT.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED TIME PHONE FAX INITIALS REVIEWED YES NO I REVIEW DATE 6�JC) �1 r� ._li, .., FILESvA 1 SEEM q UNDERGROUND TANK (UST) CLEANUP SHE (LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY i %''I tq OTHER CLEANUP SITE (NON -LOP) ..�.l1�nni,nZiI=r-1MOM ❑ SOLID WASTE VEHICLE L)t UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL BI DAIRY M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH , . ,►��IIr, ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL INIMll' 1101lt2IIIM I7 -POOLISPA - • , M LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) 1_ List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above - 2.. 2. EHD will notify the applicant if any EHD files exisL An appointment for review will be confirmed. approximately five business days but no later than ten (10) days after receipt of. application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $BT.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED TIME PHONE FAX INITIALS REVIEWED YES NO I REVIEW DATE 6�JC) �1 r� ENVIRONMENTAL HEALTH DIVISION FILESvA 1 q UNDERGROUND TANK (UST) CLEANUP SHE (LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY i %''I tq OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE L)t UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL BI DAIRY M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH s3 PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUGWARD/CHEM TOILETS ❑ TATTOO[BODY PEIRCING I7 -POOLISPA - • , M LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) 1_ List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above - 2.. 2. EHD will notify the applicant if any EHD files exisL An appointment for review will be confirmed. approximately five business days but no later than ten (10) days after receipt of. application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $BT.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED TIME PHONE FAX INITIALS REVIEWED YES NO I REVIEW DATE