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U4-1U-2000 03:51PPI FRC' • <br /> JN'i[necnvL TO 5385852 P.02 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES enu you <br /> I '.� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-342o <br /> \ PUBLIC RECORDS RELEASE APPLICATIQI�I�; <br /> APPLICANT C,Y�2 C - <br /> BUSINESS/AGENCY � QU - _ �-I�(�I t;T.� <br /> ADDRESS a'1 ve, �r� V�Udes - <br /> Q- <br /> 0 <br /> A(,� <br /> PHONE_aVC C <br /> > 3 R - toy a� FACSIMILE D-0f) - S 3 g . S 4 ti <br /> TENTATIVE"APPOINTMENT DATE v <br /> (Please give 7 to TO business daY6 from date of eppllcat on submittal)DD <br /> w •� <br /> .Z CHECK BOX TO EXPEDITE REQUE T-$78.00 FEE—R UEST PROCESSE IN 3 BUSINE S DAYS R 19 2 <br /> SIGNATURE OF APPLICANT <br /> L4L.1V DATE O O <br /> FILE ADDRESS <br /> THIS SIDE EHD STAFF USE ONLY <br /> S PROGRAM ELEMENTS SEARCH <br /> A r ec. cc <br /> CA <br /> 0 0 0 <br /> r" <br /> G O <br /> I . <br /> E IRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(USN)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> i' UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ SOLID WASTE VEHICLE <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ DAIRY <br /> ❑ TIERED PERMITTED FACILITY ❑ PKG TREATMENT PLANT <br /> ❑ TATTOO/BOGY PEIRCING ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ MEDICAL WASTE FACILITY C3POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> • List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate bex(es). At least one file type MUST be selected. Fax to(209) 464 01$2 <br /> address indicated above, <br /> ail to the <br /> 2. EMD 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 /> accordingly. <br /> will he held for a maximum of five business days for review. Appointments should be scheduled <br /> , <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$78.00 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 <br /> TIME <br /> LDATEFIRMEDPHONE FAX INITIALS <br /> YESNOAo REVIEW DATE <br />