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22 <br /> FROM : NOA Erwironmental PHONE NO. : 209 369 4220 Sep. 25 2 2 0,1'2 M <br /> vale ncucrvcu {'/ <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH MRVICES `L v <br /> ENVIRONMENTAL HEALTH DIVISION <br /> W 304 EAST WEBER AVENUE,THIRD FLOOR ��, j�V/L CL') <br /> 5 2QOZ M STOCKTON CA 95202 <br /> SEP 2 I O (209)468.3420 SEP 2 5 2002 <br /> EN u�ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> pR <br /> PLICANT BUSINESSfAGENCY <br /> ADDRESS KL v,_ 0 <br /> PHONE I?A — D ( FACSIMILE Zoo41 <br /> r <br /> IVE'APPOINTMENT DATE TIME <br /> t ' r-1771 <br /> 'f ( ease gi/`�e�7 to 10 busines ays��{Q�n date t application submilla 7( • fid m <br /> } p�/ ,�) 3 7 SSS " :i V:..C'fµ y `y <br /> i CtIECK-BO EXPEDhE+REQUEST-$89.00 FEE- OUE T PUl S ED IN]BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ZSa � <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> LL--t-Lo <br /> , <br /> low S. afCQU( Lo a <br /> S+ �-n <br /> loin E. S+ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> /UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> (yt OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ 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 (20 9)464-0138 or mall to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD flies 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 REVIEW DATE <br />