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Oa/07/2002 12:51 FAX 209 9481 KLEINFELDER 91 U 002/002 <br /> END LOC NUMaER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> � ENVIRONMENTAL HEALTH DIVISION <br /> 1304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 710 <br /> (209) 468-3420 <br /> 02 HAR -7 PtekkENC RECORDS RELEASE APPLICATION <br /> APPLICANT / //I� / 'rc�2r�C BUSINESSIAGENCY <br /> ADDRESS ,7/-8n <br /> PHONE `7r�'75 L2� FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE �r O� A•^i• - ���� �a� <br /> 11 CHECK 80X TO EXPEDITE REQUEST 700 FFUEST PR D D 3P0 INESS DAYS) <br /> DATE /a <br /> SIGNATURE OF APPLICANT a� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM. 5 RCH <br /> �38`f l gnnel <br /> -S4- <br /> 110 <br /> 4 11D N1 i16dr4- Si .S4vckao, CA <br /> as C)"Z Filbrr Sf- s�-�klv. C 1 <br /> G AJ e~.6tr 1 S f S ti.cCc+or C,4 <br /> x388 & ;.t. say 5�4 cG moo, C/� <br /> s <br /> .2. 39 � /h.�.Gr St S•fcck{o-. C <br /> s-f S k f�LI <br /> �7/G Cr3 <br /> S4Ocd: 1/1� C <br /> ENVIRONMENTAL HEALTH DIVISION FILES FPI/SOLID UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT p SOLID WASTE VEHICLE <br /> WOTHER CLEANUP SITE(NON-LOP) - ❑ FOOD FACILITY <br /> VUNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> OYHAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> I(TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARO/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING - CIPOOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 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 file type MUST be selected. Fax to (209) 464-0138 or mail 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 /> 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 <br />