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-JUL-11-03 FRI 01 :59 PM SAIC - SACRAMENTO FAX NO. 916 974 8830 P, 02 <br /> are REGww ! ` • EMDLOGNUMBER <br /> SAN JOAQUIN COUNTY <br /> )U(_ L :( Z003 ENVIRO,NMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> n. •: _u'i ;t �LT11 STOCKTON CA 95202 <br /> p,i "ll ' "` fI (209)4683420 3 <br /> r.,rrrS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT /dl)y !aoo'L BUSIINcEESSIAGENCY <br /> ADDRESS 39CtJ /,tiYlf�vF.cXt� +*FoCA7 �ffk.ek lRl���'.(.8Y lei¢ �9Sg.;/ <br /> / J <br /> PHONECjlG) '9W--,3W/ FACSIMILE <br /> TENTATIVE*APPOINTMENTDATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$89.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DORS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> a8 <br /> D <br /> 0 <br /> 3 <br /> g�! ENVIRONMENTAL HEALTH DIVISION FILES <br /> r3 8so <br /> ❑)4DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CtFANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TATTOOBODY PEIRCING ❑ POOU5PA ❑ LAND USE APPLICATION SITES _ <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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. 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 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. <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. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> S. *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 /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ <br /> E o N 2�6 _T <br /> ]lJGl00� <br />