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-JUL-11-03 FRI 01 ;58 PM SA1C - SACRAMENTO FAX NO, 916 974 8830 P, 02 <br /> DATE RECENLU EHD LOU NumarR <br /> I <br /> SAN JOAQUIN COUNTY <br /> 111 .L X003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> i ;LAVH STOCKTON CA 95202 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY �A <br /> ADDRESS / <br /> PHONE !G - FACSIMILE / <br /> TENTATIVE*APPOINTMENT DATE TIME j 45-0-3 . <br /> (Please give 7 to 10 business days from date of application submittal) <br /> 2 CHECK BOX TO EXPEDITE REQUEST•$89.00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /r~( <br /> DDRE THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> a6- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> In J WOERGROUND TANK(UST)CLEANUP srrE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 0QTHER CI.-EANUP SITE(NON.LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(M 0 NITORINGIREM OVAL) . ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR © CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY M MOTELIHOTEL ❑ PUMP5R TRUCK/YARDICHEM TOILETS <br /> = TATTOOIBODY PEIRCING a POOU5PA In LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY a OTHER(PLEASE SPECIFY) <br /> 1. fist 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 209 464-4138 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 /> 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 PHONE FAX INITIALS <br /> ate' <br /> REVIEWED YES NO REVIEW DATE <br /> 317 611 0 0 3 <br />