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04-16-2001 00:S1.^."t-- 10 1925940% P.01 <br />I 'I rSekcavc I the LU'�NUMu.x <br />, ' SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES 1 <br />ENVIRONMENTAL HEALTH DIVISION <br />APR I Z 20 1 SOA EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 96202 <br />(209) 460-3420 e <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLIC.ANY <br />>tA LCA(Ti/y CV1)(STj1-/S/Tau5m3suceNCY <br />Y <br />ADDRESS 1 L•L� 3 �POSI Tj}s' L ST�. ZO.S _ <br />PHONE ZS' ` -1CFO - 740 3L- FA4C31hI1�fL>; e7r/ 2.S <br />I TENTATIVE' APPOINTMENT DATE <br />(Plane give 7 to 10 buslneaa days from data i <br />d- _163? <br />TIME / . 0 (V <br />:stun submittal) <br />1 SI CHECK SOX TG EXP REQUE37.00 E OCESSE IN S DAYS — <br />SIGNATURE OF APPLICAICA NT � a7� DATE '(?_ / 7 Q <br />..- <br />NIEsnift <br />•. ..1�s <br />t+� !� ..7�� <br />�Ir�l(��!S..• • i r �Z3 a <br />c1rf��tfw <br />L�li�.T!.iii <br />L,JTtFUlmENAM <br />M NAMES= ME <br />tam <br />WA 11a, Jlilillillillit., s• .tel I Y <br />iiii'A7l!�ENIM— <br />C> <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />U �r��L7D <br />OERG ROUND TANK (UST) CLEMUP SITE (LOP) ❑ HOUSING A13ATLMENT fl SOLW WASTE IIIIIllll111111�rrrj I�IILLffLL`57,, D <br />HER [; ! PAUP SITE (NON -Lop) D FOOD FACILITY ❑ SOLID WASTE <br />�NOERGROUND TANK (MONITOWNG�REMOVAL) ❑ DOG KEMEL ❑ auRT MAY -1 <br />�AZARDOUS WAST2 GENERATOR ❑ CHICKEN RANCH C PKG TREATMENT P.LANT <br />TIERED PERMITTED FACILITY ❑ MOTELIKOTEL ❑ PUMPER TRUCK/yARDTCNElt TOILETS <br />VATTOOMODY PEIRCWG D POODSPA � � 13LAin USI! APPLICATION WES <br />MEDICAL WASTE FAOLT' ❑ PURLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ADOVE) <br />1. List up to ten addrazsas 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 1209} 464-0138 Dr mail to the <br />address IndICAW Above. <br />2. EMD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximaWy five business days but no later than ten (10) days after receipt of appitcatton. The files <br />will be hold for a maximum of five buslnes4 days for revlow. Appointments should be scheduled <br />accordingly. _ <br />3. A file that is actively being worked on by EHD staff may not be Immodiataly available for rovfcw. A now <br />application may be submitted when the fills Is available. <br />4. Any Ria not raturned 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 ravlew. <br />S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />B. Applications recalvid after 3:00 pm wpl be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRmaD _ PHONE FAX INITIALS <br />