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05/01/2003 07 43 7146711008 ESS ,PAGE 02 <br /> 0G7n31Q;24, ... 46481 3 tIY':irulvnov,n� ,w^ "",w VMS,: <br /> ;,I 1I '�[ ,I SAN JOAQUIN COUNTY 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAY 0 1 2003 304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)466.3420 <br /> FNVIRuI`,ub1F:i�1 HEALIH Puam RECORDS RELEASE APPLICATION Ui 5 <br /> /�/' r.•+-e..�.Raex�rss.�.r.�,c�+.a,s.�—a..... <br /> r,APPLICANI'_- ,U�• / �'�l' a Nl�r au$iNESSlAC*NW !�i7 V(��D n . ._ :-L^� � ,(/C- r <br /> AnDR[SS <br /> 17 U0 Cecil C4y�j,� 5= —_ <br /> PHON[ `'?� &71-11.10 FACSIANLE 7 �' / 0? <br /> TENTATIVE*APPOINTNENTDATe TIME <br /> (Please piva 7 W 10 bualn�ee drrye frau ryb of appli6ellOn eubndrod) 5,q CHECK BOX TO EXPEDITE REQUEST-549.00 FEE-RE EST PROCESSED IN f BUSINESS 0AY!F <br /> 9 SIGNATURE OF APPLICANT — _..., ---- DATC -_5�•--�r—�� ---- <br /> �rll� CrNLY �I <br /> FILE ADDRESS PI206RIM ELEMENT 6(MARCH <br /> ENVIRONMENTAL HEALTH DIVISION PILES <br /> ')/UNOEROROUND TANK(UST(CLEANUP srm(LOP) ❑ HOUSING AMATSMYNT M 8OLK)WATTS IrAC:ILITV <br /> fOTHER CLlANUP SITI!(NON-LOP) ❑ FOOD fACILITY 0 UCILK1 WA;TE(VFI-11CLE <br /> UNDIEROROUNO TANK(MONITORINGIREMIOVW ❑ DOG KENNEL tl ojiwr <br /> HAMDOUS WASTE OENERATOR 0 CHICKrN RANCH [] PM:I�'r RSA'rMRNT(PLANT <br /> 7it"DPERMIT1`120 FACILITY 0 MOTELFHOTeL ❑ l/IVb'OR U4S MrpLK:ATION RAI TOILETS <br /> ❑ TATTOOISODYPEIRCING 0 POOLMPA <br /> ❑ MEDICAL WASTE FACILITY ❑ 07HEFL(PLEAS!SPECIFY) --.—.- <br /> 1. List up to ten addresses In the Space above. Select the type(s)of flies from th n lint above by shacking <br /> the appropriate box(ea). At least one file type MUST be selected. ;SIL.(I�.Q�.jft2;(�$..or m ill IM hip, <br /> address Indicated above. roylevi will b* <br /> ed <br /> 2 appOintmOrit for <br /> approximately five buSi a <br /> s day but EHD will notify the applicant If any nollatcr than ton les exist. (10)days Ow rhOPIlpt of ripplicad nI.nTN9 files <br /> will be hold for a maximum of five business days for review. Appnintmenta et.oufd tsn scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediateAy atiaileblo for rovi9W. A now <br /> application may be submiteed when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganh[ed by EHD staff at the axpenao <br /> of the applicant. Future file reviews by the rime applicant may require a $99.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> S. Applications received after 3,00 pm will be processed the next buniness stay. <br /> CONFIRMED APPOINTMENT DATE __ TIME --- <br /> DATE CONFIRMED PHONE FAX IIVPItAI.B � II <br /> REVIEWED YES NO _ REVIEW DATE,,. <br /> .aw <br /> Yteuw <br />