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07/08/2002 M0IN 12,50 FAX 916 5654356 N01/001 <br /> u�r uer eau[ tn:vB a dN ENVZRa44DgTL�ALTH PAGE 91 <br /> *N JOAQUIN COUNTYPUBLIC 14EALTH SERVICES � "9t'aaxa°m <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, <br /> THIRD FLOOR I / <br /> STOCKTON CA 95202 <br /> )468-3420 <br /> PUBLIC RECORDS RELEASE APPLICA11ON <br /> APPLICANTI'�rf/r,>pa I <br /> t\ � �BUSINESSIAGENCY1y1,a,J <br /> AdbRF-Ss <br /> PHONE � n— • <br /> t=ACSIMILE �/�i' S <br /> . TENTATIVE'APPOINTMENT DATE <br /> p1 (Ple=a give 7l 1 nnnEaPPil auhmlttal) <br /> CHECK 80X Tp ExPEDITE REQUEST- ,eC p <br /> --� QU ST OCEdSjf] [NESS DAYS <br /> SIGNNT'URE OF APPLICANT - <br /> C; DATE oL <br /> FaE ADDRESS THIS SIDE EHD STAFF USE-ONLY <br /> PROGRAMALEMENTS SEARCH <br /> � / z <br /> L. Al B/� - i✓ <br /> Z <br /> Lr/ <br /> z� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Rf UNDERGROUND TANK(UST)GtEANUP SITE(L.OP) o ROUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> D OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> CI UNDCRGROUND TANK(MONITORwGIREMOVAL) ❑ DOC KENNEL ❑ DAIRY <br /> la HAZARDOUS WASTE GENERATOR, ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> d TIERED PERMITTED FAcILrrY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDfCtteM TOILETS <br /> ❑ MEDICATATrOOL <br /> WASODY pE ACm0 ❑ POOL/SPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL wASTH FACILITY , - ❑ PUBLIC WATER SYSTEM o 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 oho file type MUST be selected. Fax to 2139 464.0138 or mall to thei <br /> address indicated above. , <br /> Z- EHD will notify the applicant if any EHD Ries 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$89,00 deposit prior to review, <br /> 5- '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 RLVjMDnTG „ .._ <br /> m <br /> Post-a'Fax Note 7671 °g0p7 r'L °°aee1oz� <br /> Ta From <br /> a <br /> WWI <br /> rnorre k H10�P yL..(' dor y�- Z V <br />