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09/17/2003 09:36 FAX 209 9480"t 002/004 <br /> OATS"CvE VmO LOG NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> S E P 7 200 i STOCKTON CA 95202 114q7 <br /> (209) 468-3420 <br /> _; it,�I;;�PIPJIENT i��A11F�PUBLIC RECORDS RELEASE APPLICATION <br /> GI , VIUL-�' -- <br /> APPLICANT \J 1 -1Si�Fa=,S BUSINLSWAGENCY ���t"Lffr-L.Qy1� <br /> ADDRESS <br /> PHONE Z0C /�Tt- z) FACSIMILE �9 7 '�IL)F� ZI <br /> TENTATIVE'APPOINTMENT DATE _( 0 3 TIME Z <br /> (Please give 7 to 10 business-days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•; 7.110 F —REQUEST PROCESSED IN 3 BUSINESS DAYS I <br /> SIGNATURE OF APPLICANT DATE <br /> LILL <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Z-3 ' I i A <br /> 2r,3, cA ?-V I <br /> lN,, <br /> -Z'4 OZ eta., <br /> 1=10 EELSkr �r I! (r <br /> la 5 (0 " 1' V �. _ l ' <br /> lop <br /> ENVIRONMENTAL HEALTH DIVISION FILL=S <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILrTY ': ':h,"0 <br /> q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAC(U'TY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/R2MOVAL) ❑ DOG KENNEL W DAIRY <br /> FAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL(HOTEL 0 PUMPER TRUCK/YARDICHEMTOILETS <br /> ❑ TATTO01BODY PEIRCtNG ❑ POOL/SPAio LAND USE APPLICATION SfTES <br /> ❑ MEDICAL WASTE FACILTrY 13PU13UC 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 mall to the <br /> address)ndicated 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 tiles <br /> will be held for a maximum of rive 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 reVlew. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm wit[ be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME,. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RLI- EYVED YES NO REVIEW DATE <br />