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12/05/2002 12:10 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED END LOG NUMOER <br /> SAN JOQUIN COUNTYPUBLIC HEALTH *VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> D E C o 5 ZOOZ STOCKTON CA 95202 <br /> (209)468-3420 ©u <br /> I_rw R INMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCAN7 `` BUSINESSlAGENCY <br /> ADDRESS 3 0 Q L �/^ <br /> PHONE (040/7 9 �uCJ FACSIMILE Y&Iry y; 1 —/O 10 <br /> /-:;L//­,0 /`" <br /> t�f/(/ /`" �7ues/W TIME .11L� /f• Q ,rpc, � , <br /> TENTATIVE APPOINTMENT GATE d <br /> (Please give 7 to 10 business days from date of applicatlan submittal) 7Se ' LI V ` <br /> to <br /> 'Pt CHECK BOX TO EXPEDITE REQU T-$1111.00 FEE REQUEST PROCES DIN 3 BUSINESS DAYS / r 7M 1, <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> r c <br /> r r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(U5T)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> �17 HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> D'YlJNNDERGROUND TANK(MONITORINGIREMOVAL) ❑ OOG KENNEL O DAIRY <br /> fYHAYARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELlHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY FORCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 hall 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 tan(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$78.00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must he 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 /> IN 00 14 01N 0 <br />