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FEB-25-03 12 :54 PM P. 01 <br /> 02. 5!JN�7!FIP:,04 aE� ENVIRCUVE"-rA_ HE:L,�,� PARa,niirn,�ncn <br /> SAN ' OAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> FEB 2ENVIRONMENTAL HEALTH DIVISION <br /> 2003 304 EAST WEBER AVENUE,THIRD FLOOR ! <br /> STOCKTON CA 95202 I <br /> ENVIi;UII'��,,;Fnrr r;EALT (209)468-34x0 <br /> PFS'"'T' F;VICAI IC RECORDS RELEASE APPLICATiON ; <br /> APPLICANT -DUSINESGIAGENCY _•1'_J'AJ.Z_..1- LU(.�4r�1J <br /> ADDRESS SFO <br /> T�PHONE <br /> THN3YATIV['APPl71NTIT <br /> TDATE TIME — <br /> c- n n (ro give 7 to 10 buslrwss days from dale of sppnta(lon sulmllla') •i <br /> CHECK SOX TO EXPEDITE REQ440.00 FEE-REQUEST PROCESSEO IN 19JSIVESS DAYS <br /> "SIGNATURE OF APPLICANT <br /> FILE AO RESS THIS SIDE E:40 STAFF USI:ONLY <br /> PROURAM lii_QMCNTfi SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> D SOUSING At3llTENENT O SOLIDWASTE:FACILITY ! <br /> 'I t Nt tRGR0Uti0 TANK(U5�Ct.EA UP 31TE(LOP) O F000 FACILITY O SOUR WASTE%%.NtCLE <br /> OTRER GLEANUr'SITF IN LOP) d DOG FACILITY <br /> 0 DARY <br /> LNDEAGROUND TANK(MONITORI GmEmOVAL) p pKr,,TItEATMEN'r PLANT <br /> HA2AItOCUS WASTE GENERATOR O CHICKEN RANCH p pUMFER TRUCKeYARDY'It M'eOILrATS <br /> Q YMIXED PERMITTED Kt.CtLI4tbox(e <br /> n MOTL'UHOTEL p LANC USE APPVC NTION S .Es <br /> TATTOOIS30Y PGIRrING O PCOUSPA m oTHCR(PLEASE SPECIV-Y DOVE-# <br /> U Mr.0tCAL WASTE FACILITY , <br /> _ 1, List up to Ien an the spaeo above. Select the typa(s)of files frvrtj the 11:►t above checking <br /> the approprialoAt least ane fila type MUST ba selected. Fax to x_( 09;464oad rdicb2 EHD will notifyant I!any EHD files exist. An appointmon!for review will blicationnThe fUcs <br /> approximately five, bu mess days but no later than ton(10)days after recolpl of app I <br /> will be held for a max mum of five business days for review. AppointrTlerts should be schedulad <br /> accordlrluly. <br /> 3. A filo that,iq actively oinfl worked on by EPO stiff may not be inllncdlately availatalt for re�)cw. A now <br /> aapiicatton may best omitted when t1,10 filo is available. EWD staff at the expanses <br /> 4. Any file not retumed n the same condition as rolcased will be reorg artired by <br /> of the applicanL Future file reviews by the same applicant may require a=R9.00 tieposil pr(or to review. <br /> 5. 'TENTATIVE appointinont dates must be confinnod with END staff. i <br /> Q. Applications recalvet atter 3:00 pm will be processed the next business day. ' <br /> CONFIRMED APPOI NTMENTDATE TIME __ —t--- <br /> uA'TE CONFIRMED PHONE rAX lN1T{A1.8 <br /> REVIEWEDYES _ NO REVIEW DATE =.�s��,�- <br /> --,-_ <br /> v 3. -blir+ 'JM IV files �n z <br /> a- a5- - <br /> I <br />