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JUL-11--03 FRl 01 :59 PM SMC cACHMENTO FAX NO. 916 974--8830 P. 02 <br /> SAN JOAQUIN COUNTY EF4DLOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> HL��i 1, ZJa3 304 EAST WESER AVENUE,THIRD FLOOR 07y , <br /> i i - ' STOCKTON CA 95202 I t�-1-S (209)468-3420 <br /> �'r''�`` ^�'„� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT�dt�[)_ BUSINESS/AGENCY <br /> ADDRESS <br /> PHONE FACSIMILE / <br /> T1=NTATIVE*APPOINTMENT DATE _ ITIME <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 t1offil <br /> SIGNATURE OF APPLICANT _ I DATE <br /> DRE T141S SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> r <br /> • Cs7� <br /> _ d <br /> I <br /> 3 i <br /> �' �EN�VIRONMENTAL HEALTH DIVISION FILES <br /> � <br /> Q� DERGROUND TANK(UST)CLEANUP SITE(LOP) EI HOUSING ABATEMENT t] SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON.LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE. <br /> O UNDERGROUND TANK(MONITORINGIREMOVAL) . 0 DOG KENNEL 0 DAIRY <br /> Q HAZARDOUS WASTE GENERATOR d CHICKEN RANCH I 0 PKG TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEMTOILETS <br /> 0 TATTOOIBODY PEtRCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY a OTHER(PLEASE SPECIFY} -- <br /> 4: 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 revltw. 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 now <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 fife reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confinned1with 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 PHONE FAX INITIALS <br /> REVIEWED YES i4o REVIEW DATE - <br /> r=boss-ox,oaa <br /> ancrsoo� <br />