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Ia003/004 <br /> 09/17/2003 09:��3jj7 FAX 209 94806 <br /> io�ra"TERE�',�'f EM LOG nuweea <br /> �I CC SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> l��i__;\^ --II 1I ENVIRONMENTAL HEALTH t)IVISION <br /> SEP 17 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> �WRONMENI HEALTH (209) 468-3420 <br /> pFR%IITiSER414C�E5 PUBLIC RECORDS RELEASE APPLICATION (� <br /> APPLICANT K-i 111 f-� �T�C l�i., BUSINESSIAGENCY k'1 L" <br /> ADDRESS �J�'7IQ <br /> r7)� � F^� <br /> PHONE w.J._:._ gro-1.V FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE 9 O TIME <br /> (Please elve 7 to 10 6 Ines days h o date or UPP"tlan--rnittal) �- <br /> Q CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE— QUEST PROCESSE�4 aBUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT �" 9 <br /> FILE ADDRESS THIS SIDE EHL STAFF lISE ONLY? A, .. <br /> PROGRAM ELEMENI'r;,.SEARCH_ s , <br /> CJS. 5-r�oc.>LIvrLIt <br /> , - <br /> S <br /> 6 1-1"TC Hw 9 S7a cxL--o/J <br /> LA <br /> 0111 <br /> S46 IJ. <br /> 5 O LD .SPOD AJE L.✓•t7 . <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 17 HOUSING ABATEMENT IIB SOLID WASTE VEHICLE /%i('' -'` <br /> Al <br /> Q OTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> qt UNDERGROUND TANK(NONITORINGIREMOVAL) ❑ DOG KENNEL SF PKG TREATMENT PLANT <br /> LH HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPF.RTRUCWARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTE❑HOTEL <br /> • TATTOON3oDY PEIRCING ❑ POOLISPA - ' Oft LAND USE APPLICATION SrTES <br /> Cl MEDICAL WASTE FACILITY ❑ PUB❑C WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one rile type MUST be selected, Fax to 209 464-0138 or mall to the <br /> address Indicated above. . <br /> 2 EHD will ent for review wi b <br /> approximately fi e business days but no later than en (0)dant if any EHD files exist. An ys after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that I$ actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application may he submitted when the file Is avallable. g y expense <br /> 4. Any file not returned In the same condition as released will be reorganized EHD staff at the exp <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to reVleW. <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 r — <br />