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AGE STOCKTON F'I"'�` Gl/d1 <br /> 02/01/2002 16:04 20946 EHD LOG NUMBER <br /> SAN JOAQUIN COU TYPUBLIC HEALTH SERVICES <br /> ENVI N HEALTH DIVISION <br /> 304 EAST WE ER AVENUE,THIRD FLOOR 744 ^ JN <br /> ST CKTON CA 95202 <br /> 209) 468-3420 <br /> PUBLIC RECOR S RELEASE APPLICATION <br /> APPLICANT U?-Q. K $I ESS/AGENCY yalvid F I <br /> ADDRESS /f A <br /> PHONE RQ5) yh AZ6 FACS MILE <br /> TENTATIVE"APPOINTMENT DATE O TIME <br /> \rJq/J (Pleas Hive 7 t 10 be ' ss da s from to of application submittal) <br /> /-� CHECK BOX TO EXPEDrrE REQU - Ilt EE- E S D IN 3 BUSINESS DAYS <br /> /SIGNATURE OF APPLICANT DATE <br /> FI E ADDRESS <br /> 35.�t, • <br /> 35•at. F B - <br /> I Cl l <br /> 1 0 <br /> D <br /> S <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HO SING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FO D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) O DO KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHI KEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MO EL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRGING ❑ PO LISPA - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PU LIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space abo e. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file ype 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 fil s exist. An appointment for review will be confirmed <br /> approximately five business days but no I ter than ten (10)days after receipt of application. The files <br /> will be hold for a maximum of five busine s days for review. Appointments should be scheduled . <br /> accordingly, <br /> 3. A file that is actively being worked on by HD staff may not be immediately available for review, A new <br /> application may be submitted when the fil is available. <br /> 4, Any file not returned In the same conditio as released will be reorganized by EHO staff at the expanse <br /> of the applicant. Future file reviews by th same appllCant may require a$78.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be onfirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 4P 00 14 U1ID 00 <br />