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03/21/2002 17:25 20° ?1118 AGE STOCKT01, e �P <br /> GATE RECEVED t� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH.SERVIC <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 384 EAST WEBER AVENUE,THIRD FLOOR <br /> T STOCKTON CA 95202 <br /> (209)40.3420 1 <br /> UBL1C RECORDS RELEASE APPLICATION <br /> ' � rr <br /> APPLICANT III ABUSINESSIAGENCY <br /> i. ADDRESS 2 3 9 4. <br /> [r) L2 _ /� / �FW, <br /> PHONE <br /> / ld / �t/�Ie� FAC31MII.E�J� / �I} <br /> ' <br /> TENTATIVE'APPOINTMENT DATE 427 1nQl f i_ �aa1 TIME ��� — �0�� <br /> "I (Please giv 7 �6 huslnass day fromte of piir,,�t' n submittal) ' <br /> l=N VH,1011d1-0.h 1T FIEALTH <br /> CHECK BOX TO EXPEDITE REQUE $.00 FEF.—REQU s Pko SS D BU ESS DAYS F P1.101 I `- -�i�ruE <br /> SIGNATURE OF APPL 1CANT DATE <br /> I� <br /> �3 <br /> FILE ADDRESS <br /> -i�tao dafesse-1 ±a r II <br /> LF A T A _�2_ <br /> 42 5'2 • sWld ad 5000 q <br /> S4 r 6ef :2 <br /> 57. IJ <br /> I . <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> If <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSING A13ATEMEAT l`*}� <br /> SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONiTORINGIREMOVAL) ❑ DOG KENNEL } ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH I 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELlHOTEL ❑ PUMPER TRUCKIYARDICHEM-TOILETS <br /> ❑ TATTOOlHODY PEIRCING ❑ POOLISPA Ij <br /> C7 LAND USE APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> i� <br /> 4 1. List up to ten addresses in the space 2�bove. Select the�,type(s) of files from the list above by checking <br /> the appropriate box(es). At least one flle We MUST be selected. Fax to (2091-464-0138 ormai€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 (�0)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 /> { <br /> 3. A file that is actively being worked on by EHD staff mayl 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.- f=uture file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed to next business day. <br /> CONFIRMED APPOINTMENT DATE li, TIME <br /> DATE CONFIRMED ---__.--- PHONE �j FAX INITIALS <br /> I� <br /> REVIEWED YES NO REVIEW DATE <br /> EH 90 14 0110SMO <br /> 1 <br />