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06/14/2004 16:13 FAX 209 948062- <br />. p TE RECEIVED ✓ SAN JOAQUIN COUNTY <br />�EC�_ , 1\! / ENYIRONMENTALHEALTHDEPARTMENT <br />`�304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />JUN 14 MtO9) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaqinn.ca.us/chd <br />ENVIRUMIENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />n a;a_t;YA <br />BUSINESS/AGENCY: <br />ga— / 3Y �_ FACSIMILE: C;2D /— 9 V j? -0 (oa / . <br />TENTATIVE' APPOINTMENT DATE: G /,-?�o 3 nine:� oa .OM <br />(Ptease allow 70 buslnese days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE – REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPUCANTDATE <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Deoaronerd Use Only <br />UNIT <br />❑ Unit 1 <br />Unit <br />_ I 41!r-Unit4 <br />❑ Unit 5 I <br />y169-�v <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye 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 $93.00 deposit prior to review. <br />S. '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 />YES <br />TIME <br />REVIEW DATE <br />SOLID WASTE F - <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />E3 HOUSING ABATEMENT <br />,Y <br />)9. OTHER CLEANUP SITE (NON4-OP) <br />O FOOD FACILITY <br />SOLID WASTE VEHICLE <br />J� UNDERGROUND TANK (MONRORING/REMOVALL) <br />13 DOG KENNEL _ <br />C1 DAIRY - <br />� HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />❑ PUMPER TRUCKAYARDICHEM TOILETS <br />❑ TIERED PERmrrrED FACILITY <br />O TATTOO/BODY PIERCING <br />❑ MOTEL/HOTEL <br />❑ POOLfSPA <br />LI LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY <br />0 OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye 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 $93.00 deposit prior to review. <br />S. '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 />YES <br />TIME <br />REVIEW DATE <br />