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Oq �Mar -31 . 21003 5:33PM 04 EARTH TECHNOLOGIES Vo ;:279 P 1/1 <br /> I��3 L,II 11�� Irl • `e N9 LOG NOWER <br /> � ,� SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> OR 0 1 -2.003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOGCTQN 95202 <br /> EDJVIR.,!'vi�4r.iJT t;EALTH (zas) aha-3-3 420 <br /> PERI'A1T/SERVICES PUBLIC RECORDS RELEASE APPLICATION AN <br /> APPLICANT a_ C40aX4147_ SUSINESSIAGENCY <br /> ADDRESS <br /> PHONE r �"! Z'I FACMILE <br /> TENTATIVE`APPOINTMENT DATEasllwE �7d000RGGG.�///''��,,� <br /> (Plee gyve 7 to 10 butane Rola <br /> .S days date of appliadon subFnU�il) --� 27 <br /> 14 <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS U n,4 9. /, <br /> SIGNATURE OF APPLJCANT o�`t s i' DATE <br /> FILE ADDRESS THIS 510E i:HD 9TA!FFUSE ONLY n <br /> PROGRAM ELEMEN'9 SEARCH <br /> r0// — <br /> L <br /> y <br /> S' re o < <br /> -7 - <br /> gI <br /> X60 1<• ,. .I - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT P'SQLID WASTE KAP , <br /> 0-0-MER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY soUn WASTE lIFI1I{�i <br /> ,ar UNDERGROUND TANK(Q/ON.LTORINGIREMOVAL) ❑ DOG KENNEL CI AIRY <br /> )3 HAZARDOUS WASTE GENERATOR ❑-CHICKEN RANCH VPK�G 7TaFA7MENT PLANT <br /> n,ERED PERMITTED FACILITY L7 PAOTEllHOTEL ❑ PU14Pi°RTRUCHTARDICHENT0Ii.ETs <br /> ❑ TATTOO/BODY PEIRCING ❑ POOIJSPA " ' ❑ LAND USE APFLICATION Sn'0 <br /> ❑ MEDICAL WASTE FACT M ❑ PUBLIC WATER SYSTEM ❑ OTHE+-L FLEASE:PECIFYA130YE) <br /> 1. List up to ten addresses in the space above.. Select the type(s) of flies from the 11:3 t above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209) 4C><LO't38 or mailer^__(t9 the <br /> address indicated above. <br /> 2. EHD will notify the applicant N any EHD files exist. An appointment for review will bs 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$87.00 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 /> ,�, `♦-1 Off 1 (e-N rkw57 2U cGrt.L_s g; o�`fo✓YJ l II <br /> naTF PnWCIDu;=rj <br />