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Q IF <br />NWW <br />DATE aLco V ED ENO LOG Numam <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />.SEP 2 2 2000 ENVIRONMENTAL HEALTH DIVISION <br />..`` <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />ENVIRONMENT HEALTHW STOCKTON CA 95202 <br />PERMIT/SERVICES (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT K -C, C -Mw oftq 13USINESSIAGENCY L'IC.ITl:GI 1'i I.tG• _ <br />ADDRESS ZS M ILS -60 <br />PHONE FACSIMILE Z��•f'4'8'��•t <br />TENTATIVE' APPOINTMENT DATE_(D,I.�3�� TIME I�`oo <br />(Please give 7 to to husinatti' days from daw of application submittal) <br />M CHECK BOX TO EXPEDITE <br />SIGNATURE OF APPLICANT <br />IN 3 BUSINESS DAYS <br />DATE 9-2.2'00 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (USTI CLEANUP SITE (LOP) <br />� .. �� • 1I�1.4ri�3U� <br />� �I <br />l��•�1NJ,''�J'i'Il/_lifil�fi'i <br />❑ FOOD FACILITY <br />❑ SCUD WASTE VEHICLE <br />r� UNDERGROUND TANK (MONITORINGIREMOVAL) <br />IVA %►i.� • s• _ 1J[V11�i�i7�rs� <br />P DAIRY <br />>r HAZARDOUS WASTE GENERATOR <br />11 CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (USTI CLEANUP SITE (LOP) <br />X HOUSING ABATEMENT <br />12r SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SCUD WASTE VEHICLE <br />r� UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />P DAIRY <br />>r HAZARDOUS WASTE GENERATOR <br />11 CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKMARDICHEM TOILETS <br />❑ TATTOOIBODY PEIRCING <br />❑ POOL/SPA - <br />❑ LAND USE APPLICATION SITES <br />Cl MEDICAL WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />100 <br />1. List up to ten addresses in the space above. Select the type(s) of flies from the list above by checking <br />the appropriate box(es). At least One file type MUST be selected. Fax W (209) 464-0138 or mall to the <br />address Indicated above. <br />2. EHD 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 />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- 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 $87.00 deposit prior to review. <br />5. '"TENTATIVE appointment dates must be confirmed with EHD staff. <br />5. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX <br />REVIEWED YES <br />iaYIfsl L <br />INITIALS <br />