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05/01/2003 07:43 7146711008 ESS PAGE 02 <br /> — 045.0/1003 1Q'' e4c6401 <br /> CIY'�lr'.uivl,u,i n� t n�wrw.JWYk <br /> SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT' <br /> MAY 0 1 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> sTOCKTON CA 95202 <br /> (09)468.3420 <br /> F^i\!IRtil,'.?'1t:ivi HEALTH PUBLIC RECORDS RELEASE APPLICATION vv <br /> -,r,r"I"r rnnnCC l <br /> -u-7 1. } } a c •i/N eU91NEssrA6EN®Y vl ��� ._SWE 1 ^�f�� vc� <br /> /'APPLICANT_ ,�. <br /> ADDRESS a��o c, r._� ---- <br /> /61 PHONE / ��il / �'� / ��/ FACaU41l.E 7 � n 7/�_ <br /> TENTATIVE'APPOINTMENT DATE _,____ TIME ..�---- 5,�(,�3 ✓ �� <br /> riaba"give 7 to to buelnees days from dab of apoolat(on eu6mlrorl) <br /> • <br /> CHECK BOX TO EXPEDITE REQUEST-f66.d0 FEE-RE EST PROCESSED IN f BUSINESS DAY" <br /> -� - 51q <br /> <.. <br /> -�(SfGNATURE OF APPLICANT <br /> �=OATC <br /> TTI [�CIP'�'/ t, r�Al~UfiB GNLY �I <br /> FILE.ADDRESS PAMRI AI ELEMENTU�InARCH <br /> Q /V. <br /> o a itT- W{r --- <br /> p 1 J <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 'T UNDERGROUND TANK(US?)CLCANUP$ITE(LOP) ❑ HOUSING ABATiMOW ❑ 6CILM wAI TB FAr:JLITy <br /> ❑ FOOD FACILITY ❑ eCILKI wAITri IfFNICL£ <br /> OTHER CLEANUP SIT!MON-LCPI <br /> UNDaRGROUNO TANK(MONRORINCfREMOVAU L7 DAIrr O DOO KENNEL t3 PP',G'rMjXnASrIT PLANT <br /> KA7A.RDOUS WASTE GENERATOR ❑ CHICKSN RANCH <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HoraL O FLI"ar'aR Ta1CKlYARDICNaa1 TGILETS <br /> O TATTOOIBODYPEIRCING ❑ POOVF.PA ❑ UND USa AFPLK;ATION BITCH +' <br /> ❑ uEDK:AL WASTE rACILrTY in OTHER(PLIFASE <br /> 1. List up to ten addresses In the Specs above. Select the type(S) of f as from the Ihst above by ehackln9 <br /> the appropriate box(es). At least one file type MUST be selsotad. ;F '�4>)!L wQ:lr .Q!'m' I j '• <br /> address Indicated sbbye <br /> 2- EHD will notify the applicant If any EHD file&exist. An appointment for revlevl will bo Confirmed <br /> approximately flue businsss days but no Istcr than tan (10) days a�lft rI n ts r!�uld b*pi s oh•du*dfile, <br /> will be hold for a maximum of five business days fvr review. App <br /> accordingly. <br /> 3. A file that Is actively being worked on by CHD staff may not be imrnedlntegy alrailable for ravfow. A riew <br /> application may be submitted when the file i--s available. <br /> 4. Any fila not returned In the Same condition as released will be reorgagb:ed by 19H0 staff at the expen^:e <br /> of the applicant. Future file reviews by the game applicant may require a •K8gsiO deposil prior to roviOW. <br /> 5. 'TFNTATIVE appointment dates must be confirmed with EHD Staff. <br /> S. Applications received after 3:00 pm will be processed the next buninasa day. <br /> CONFIRMED APPOINTMENT DATE TIME _ __._,_ --•_ — --- I <br /> DATE CONFIRMED PHONE FAX inn ow; <br /> REVIEWED YES NO _ REVIEW DATE.,.,_,,,,,,,,„,.„�..... <br /> .vzvnor <br />