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MAR-08-2002 16:27 CAMBR I R • 1707`935 6649 P-01101 <br /> NUMULK <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION qz <br /> n:.hl.�• 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> 0 Ii�R -3 PH I-PALIC RECORDS RELEASE APPLICATION <br /> coo APPLICANT T'1 f�•o I BUSMESSIAGENCY `�-�'m'• ' lA- VtYOY�YYI� 1n 1 <br /> ADDRESS '"10 klYvG Y�G't" SOY'loy"?t (A <br /> PHONE (7o7) 9303- 23(68 FACSIMILE 001) 2S45- !0(049 <br /> TENTATIVE'APPOINTMENT DATE � TIME 0 C) <br /> ( op'v Tto n ays ff aate ct al) kation submittal) <br /> 13 CHECK BOX TO EXPEDITE RE D�FE T PROC�S1 )INp BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ^\ �t -+ DATE -3 B b� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> -1'100 !Vlore u ck ss 8 <br /> 441. W. • hariat^ S Cc aV <br /> 50$ W, G ar W 3S•a+. <br /> l.:in c o l t'1 S 35sy <br /> 14-44 <br /> LWCAEL4 6+rf' l- k- sat, S <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT C SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> V7/OTHER <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOC KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY - ❑ MOTEUHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING Cl POOL/SPA ❑ 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)east one file type MUST be selected. Fax to 1209)464-0138 or mail 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 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 /> S. "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 /> DATE CONFIRMED PHONE. FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE: <br /> TOTAL P.01 <br />