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{ FR hi : NpA Env i rorunenta t R-UgE NO. : 209 369 4228 �� Dec. 23 2602 12::24PaMw�pP�12� <br /> I! it - WD kDO MJUB?R <br /> SAN JOAQUIN COUNTYPUBLIc HEALTH SERVICES � <br /> C,.ENVIRONMENTAL HEALTH DIVISION <br /> �l,,'304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202° <br /> 2 3 20 209�2 d )468-3420 <br /> �rf r,l I/If-M1, PPPLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r'� -31 '11 BUSINESSIAGENCY <br /> j ADDRE=SS !V . iol <br /> PHONE' 'FACSIMILE <br /> FACSIMILE20S <br /> TENTATIVE*APPOINTMENT DATE ZOo3 TIM s E <br /> (Please givo 7to10 �ns <br /> ays <br /> days Tram date at 9001catlon submittal) <br /> CHECK BOJ(TO EXPEDITE REQUEST-$69.00 FEE.-RE ST P OCESSED IN 3 DUSiHESS DAUM <br /> SIGNATURE OF APPLICANT ii DATE f 2— <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM El 1! EWI%SEARCH <br /> aea, <br />� Il <br /> i;. <br /> S ( Ir <br /> 10 <br /> II <br /> el <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT,! Q SOLD WASTE FACILITY <br /> §a' OTHER CLEANUP SITE(NON-LOP) a FOOD FACILITY (3 SOLID WASTE VEHICLE <br /> JU UNDERGROUND TANK 1 oNrrORINGIREMOVAL) Cl DOG KENNEL 0 DAIRY <br /> S( HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH t7 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ moTELIHOTEL I, ❑ PUMPER TRUCK/YARDlCtI[EI►1 TOILET". <br /> C2 YATT0018oDY Pt:IRClNG ❑ POOLISPA „ G LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PU13UC WATER SYSTEM 51 GTHER(PL.EASE SPECIFY ADO <br /> 1_ List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At[east one file type 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 files exist. An appointment for review will be cerifirrned <br /> approximately five business days but no later than ten (10)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 /> 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. 11 <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. Future file reviews by the some applicant may require a$89.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with dHD staff. <br /> G. Applications received atter 3:00 pm will be processed the next business day. <br /> i <br /> 4 CONFIRMED APPOINTMENT OATS. TIME ' <br /> DATE CONFIRMED PHONE FAX lN1TlALS <br /> i} <br /> REVIEWED YES NO REVIEW DATE <br />