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2-21-203 11 .SAAM FROMjjNAS AND ASSOCIATES 92S 37A 00— P. 2 <br /> 0�3� 20r: 7ii _4,84 38%ZQ <br /> ENVIRONMENTAL WAL7H PAGE 02 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES 4b'toc ay.°i <br /> FEB 2 1 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 1163 <br /> ,r,ViUEPJTHEtiL7H srocxTONCA3szoz <br /> 'nH/SERVI;ES (209)466-3420 <br /> PU13UC RECORDS RELEASE APPLICATION <br /> APpUCANT i BUSINESSIAGENCY. JQ7•A0.� •�- I�a�n, : s.••• <br /> ADDREss O �� - <br /> PHONECCG -.37 —bbZO Z g RL 57 <br /> FAI?s1MILE CS Z <br /> TENTATIVE'APPOINTMENT bATe—tALgLj• 20O-" _ - � .�_L'13 <br /> (p4x10 pha 7l0 14 bualnafa rren, l'ra1E <br /> dale el'aPyapypA aVbmllia l- <br /> CHECK BOX TO EXnOITE REQUEST-M.ep FEE-•REqXfSTPROCME0 M]OUSINESS OATS <br /> `SIGNATURE OF APPLICANT DATE L ty 2t,3 - <br /> '�d <br /> Fa-E ADDRESS THIS SLOE ENO STAFF uW ONLY <br /> PROGRAM ELEMENYS GI;ARCH <br /> " 520 <br /> N <br /> — — <br /> 1/ ENVIRONMENTAL.HEALTH DIVISION FILES <br /> [7Tn UNOERGROUNO TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMFNT ❑ $QUO WASTE FAGLrTY <br /> {{{///410THER CUEANUP srm(NON{Op) t7 FOOD FACILITY 0 SOLID WASTE VE1114.12 <br /> �c (5,UNDERGROUND TANK(MONtTOR1NCIRtr4gvAL) ❑ DOD KENNpy n DAIRY <br /> •'n. &,HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH 0 PKI)TREATMENT PLANT <br /> u TIERED PERMITTED PACILrrY O MOTELh1OTGL O PUMPER TRUGKryfutD/CHEM YOK_SETS <br /> O MEOCAL WASODY I!FACIUT ❑ POOLIZPA O LA"UsE APPLICATION sans <br /> O MEDICAL WASTQ FACILTrY O OTHER(PLEASE SPECWYAOOYC) <br /> 1, List up to tun addresses In the space above. Select the type(s)of tiles from the list UIPWO by ChocklnU <br /> the appropriate box(es). At least one file type MUST be selected. Pax to (209)46"1:3:3 or mall to tha <br /> addmss indicated above <br /> 2- EHD will notify the applicant if any EHD riles exist An appointment for review will be Lonfimled <br /> approximately five business days but no tater than tan(10)days after recelpt Of application. The lies <br /> will be held for a maximum of five business days for review, Appointments sl,vuld be scheduled <br /> aceOrdingly- <br /> 3• A filo 11111,actively being wwkud on by EHD staff may not be immediately availabte for review- A now <br /> application may be submittedwhenthe filo Is available, <br /> 4. Any file not rvttrrnad in the same condition as reloased will be reorganized by EHD staff at the expense <br /> of the applicant Future File reviews by the same applicant may require a$83,00 depo::it prior to review, <br /> v. <br /> 'TENTATIVE appointment dates must be confirmed with END, <br /> G. Applications received atter 3:00 pm will by prvcassed the next business Cay. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO <br /> REVIEW DATE <br /> bl� <br />