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03/21/2002 17:25 20AGE STOCKTO� <br /> 1118 e <br /> OA7E RECEIVED <br /> SAN JOAQUIN COUNT`(PUBLIC HEALTH SERVC u>a PGE <br /> I ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FOR <br /> STOCKTON CA 95202 <br /> it (209) 468-3420 <br /> �l UBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY :7�knsol <br /> APPLICANT n <br /> ADDRESS <br /> PHONE-201) / [sJ ! �O`' FACSIMILE rf <br /> a7 t�7 N , �[�/ TIME MAR 2 1 LU�� <br /> TENTATIVE`APPOINTMENT DATE <br /> f IiGat' n�uBmittal) _ <br /> (Please giv�l��assday (rpm�teo p � i_idT HEALTH <br /> F�,Ililvl i , -hVi�E <br /> CHECK BOX TO EXPEDITE REQUE - 8.00 FEE-REQU 5 PRO SSD BU ESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> r rr <br /> tj <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> d HOUSING ABATEMENT X SOLID WASTE FACILrrY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE" <br /> OTHER CLEANUP SITE(NON-LOP) � DOG KENNEL El DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKENMOTELJHRANTEL Cl PUMPER TRUCKIYARDlCHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ pO1JSPA t3 LAND USE APPLICATION SITES <br /> O <br /> ❑ TATTOCIBODY PEIRCING ❑ pLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> �, List up to ten addresses in the space above. Select the type(s) of files from the lista bove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (200) 464-0138 or mail to the <br /> address indicated above. <br /> 2_ EHD will notify the applicant if any EHD files exist. An appointment <br /> s review will be confirmed f applicaIon. The files <br /> approximately five business days but no later than ten ( ) Y <br /> will be hold 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.- 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 the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01105No <br />