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_11-30-2000 0E-2?RM FR0rt4/ TO %lao-1 19168610430 P.01 <br /> as�r riCt.iivtiu eso roc NwwAct <br /> SAN JOAQUiN COUNTYPUBLIC HEALTH-[ SERVICES <br /> I ENVIRONMENTAL HEALTH DIVISION �G <br /> 304 EAST WEER AVENUE,THIRD FLOOR <br /> SCOCKTON CA 95202 <br /> s (209)468-3420 <br /> BLjC RECORDS RELEASE APPLICATION <br /> IPPLICAMT jt }cr�6hie BU51NESWAG€NGY r7t GDS �Vt �G�Y16, ica✓,mt( -""e <br /> ADDRESS 3027 }C{ISD,re_ P-ona SvAc WO ?-a-C-kk CA 9567 0 <br /> tioNE qi& 1 aLloo �x} Zz, FACSIAGLE LJI to Sit! - i'u <br /> TENTATIVE'APPOIN-rMENT DATE Moxidp,, 17-1t J Av TUmB <br /> i (Please elva 7 Lo 10 business Mays from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-367.00 FEE—REQUEST PROCESSED 1N 3 BUSINESS DAYS N QV :1M- <br /> I <br /> IGNATURE OF APPLICANT DATE llf�d/oO <br /> I <br /> TW5 SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS <br /> i PROGRAM ELEMENTS SEARCH <br /> I i tj w► c�,o,rl�r w s , k�H Cs} "I gm to 3 537 1K <br /> 21 yb Clwr�c- IIID Ste[k}vw, [R F ,_ I4RCD �S•Z� -�2 _ —- <br /> 3'. CA C61-WG+ S a{�o 7 32-CP K2 i <br /> uv 515 CL,ov - <br /> 51 b7-o CAshcl! �'aph _3 <br /> 61 14 7. L:;n r--,I AV- Fn11 3 <br /> i <br /> I <br /> I ENVIRONMENTAL HEALTH DIVISION FILES <br /> i6 UNDMiGROUND TANK(LIST)CLEANUP SITE(LOIS) 0 HOUSING ABATEMENT ❑ SOLM WASTE FACILITY <br /> 9 CTHERCLEAt�itlP SITE(NON-LOP) C3FOdD FAGILfTY D SAID WASTE VEHICLE <br /> O UNDERGROUND TANK(FADNrroRINGIREM OVAL) ❑ DOG KENNEL ❑ "RY <br /> 0 HAZARDOUS WASTE GENERA-TOR D CHICKEN RANCH G PKG TREATMENT PLANT <br /> T1ERM PERMf1TEO FACILITY O NoTEUHOTEL. G PUMPER TRUCKNARDICHEM T04FTS <br /> TATTOOMODY PEIRCING - E3 POOLISPA l7 LAND USE APPLICAMN SITES <br /> G7 MEDICAL WASTE FIiG41-1Ty ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> i <br /> j, List up to ten addresses in the space above. Select tha type(5)of files from the list above by checking <br /> the appropriate lbox(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> I address indicator;l above. <br /> Z- EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> j <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> I will be held for a maxirn n'1 of five business days for review. AppointmOnts should be scheduled <br /> I accordingly. <br /> �. A file that is actively being worked an by EHD staff may not be immediately available for review. Anew <br /> i 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 /> i 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 EHG staff_ <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> r�IATE <br /> IRMED APPOINTMENT DATE TIME <br /> CONFIRMaD _ PHONE FAX INITIALS <br />