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-SUE.-11-03 FRI 0158 PM SAIL ;. SACRAMENTO FAX N0, 916 974.8830 P. 02 <br /> it EGATt:RECEIYFA Ir i i �i!_'i [3.0 E4G NUMBER <br /> SAN JOAQUIN COUNTY jp <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1�� !, ZUO3 304 EAST WEBER AVENUE,THIRD FLOOR <br /> F, <br /> i-i _ t STOCKTON'CA 95202 <br /> i LTI (209)46"20 is <br /> rk'V!('r8 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT A - - . '. DUSINESSIAGENCY �+� <br /> it <br /> ADDRESS <br /> Y o �c <br /> PHONE iG FACSIMILE�j�1 /'7~o�T 6 <br /> TENTATIVE`APPOINTMENT DATE TIME 5-J 3 <br /> (Please give T to 10 business days from date of applivaVon submittal) • �L� � <br /> CHECK BOX TO EXPEDITE REQUEST»$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT — ,# DATE <br /> ,f <br /> -t Il <br /> l DRE THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> h <br /> qul <br /> WWI <br /> -F 1 <br /> i <br /> II i i <br /> k <br /> 13�t <br /> 0 <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> C3}XbERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT +I C] $OJD WASTE FACILITY <br /> 0 OTHER CL�EANUP SITE(NON.LOP) ❑ FOOD FACILITY �.; ❑ SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONrroPJNG1Rl MOVAL) 0 DOG KENNEL D DAIRY <br /> ❑ HAZARDOUS WASTE taENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELlHOTEL I3 PUMPERTRUCK/YARD/CHEM TOILETS <br /> 0 TATTOWBODY PEIRCING 0 POOLISPA i� ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL.WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> R j <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 least one file type MUST be selected`F Fax to 209 464-0138 or mail to the . <br /> address indicated above. i <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 (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. i# <br /> 3. A file thatis actively being worked on by EHD staff may not be immediately available far review. A new <br /> application may be submitted when the file is available. �� f <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 same applicant may require a$89,00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed.with EHD staff. <br /> B.. Applications received after 3:00 pm will be processed the next business'day. <br /> CONFIRMED APPOINTMENT`DATE - --- TIME <br /> k <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES SIO... REVIEW DATE <br /> ' EHDAi42-0o6 --- <br /> ]r14fx001 <br /> r ' <br /> F <br />