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rRia'I : NOR Envirorvllental N%W PHONE NO. : 209 369 4228 Dec. 03 DAIRRECEIVE13 JOAQUIN COUNTYPUI3LIC HEALTH SERVICES ENVIRONMENTAL. HEALTH DIVISION 1 DEC 0 3 2002 V 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 ;:.PdV;s?ONIVENT 14 ALTH (209) 468.3420 Df„naIT/SFRviCRtJBLIC RECORDS RELEASE APPLICATION 2002 02:54PM P2 emu `OG NUMBER j0&5 APPLICANTYTBC'j�tLV�-r�i-CyG,O BUSINESS/AGENCY 4t* �NJIP_0NVr1ENTAL_ 7-7-T ADDRESS Z+ tD 0S ' V'~ LAt,16 LO -DI \ �� PHONE �ZD�� '1'I” "-Tµ� _FACSIMILE (7�° 340p1-�2Z.g TENTATIVE' APPOINTMENT DATE fZ" 1 z^ C'L TIME f o'- tm 0, N n71.c, (Please give 7 to TO business days from date of application subm)ittal E� fl4�2j," )'1_I)-Qa�d�^y✓) El CHECK BOX TO EXPEDITE REQUEST - $89.00 FEE- REQUEST PROCESSED IN 3UNY5, 7' L1 .1 11 SIGNATURE OF APPLICANT _{- -'" DATE cmr can cTAFF IISE ONLY • � � 111111111111111111111111111,1111111111111,1111111111111,1111111111■ • IIw111111111111'11111111111.1111111111,11111111111 nJJnU1ilU111�L7111�III�C1<�*; •IfPlom W ww.wwww�lwwwwt� ENVIRONMENTAL HEALTH DIVISION FILES 6I UNDERGROUND TANK (UST) CLEANUP 517E (LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY fi4 OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ElSOLID WASTE VEHICLE M UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13 PKGTREATMENT PLANT TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDlCHEM TOILETS ❑ TATTIHJIBODY PGIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES C] MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 1)i OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new _ application may be submitted when the file is available. 4. Any fila not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with END staff. 6. Applications received after 3:00 pm will be processed the next business day - CONFIRMED APPOINTMENT DATE. DATE CONFIRMED REVIEWED YES NO TIME PHONE FAX REVIEW DATE INITIALS SYSTEM 1)i OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new _ application may be submitted when the file is available. 4. Any fila not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with END staff. 6. Applications received after 3:00 pm will be processed the next business day - CONFIRMED APPOINTMENT DATE. DATE CONFIRMED REVIEWED YES NO TIME PHONE FAX REVIEW DATE INITIALS