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RATE RELIVED ' <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> u ENVIRONMENTAL HEALTH DIVISION <br /> 304 —EAET WEBER AVENUE,THI FLOOR- . ;r,=• ti <br /> s <br /> � STOGKTDN CA 95202,�' <br /> Mao;' �,Y (209) 468-3420 <br /> —Fet <br /> LIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q�1' i-- .--$USINESSIAGENCY -- �T <br /> ADDRESS l"0 Vfi�z� Y s� ; <br /> ; <br /> PHONE FACSIMILEMAY 2 zOOZ <br /> TENTATIVE'APPOINTMENT DATE _.� tJ l Zi!�P -Q Z nmE - VIROIIIMENT HEALTH <br /> (Please give 7 0 9D mess s frowile of4 llcat3on su rmittaf) PERMITISERVICES <br /> "I T196 <br /> CHECK BOX TO EXPEDITE REQU�-$%1140FEE !~QUEST PROCE55E1�IN I�NES AYSSIGNATURE OF APPLICANT DATE O� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH I <br /> r <br /> +1 <br /> bal <br /> I� a - <br /> 444 <br /> � <br /> C'ek c <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 90 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONUORINGIREMOVAL) ❑ DOG KEN14EL C3 DAIRY . <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 12 TATTOOIBODY PEiRCING ❑ POOLISPA CI 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 least one file type MUST.be selected. Fax to (209) 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 /> 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 /> Y . <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />