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=ROM hlOA Environmental PHONE NO. 209 365 4228 Sep. 2� 2 2 04;2 <br /> VA It:HCl:tlYtl! <br /> SAN JUAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> I V <br /> o ( ENVIRONMENTAL HEALTH DIVISION I �� <br /> 30+4 EAST WEBER AVENUE,THIRD FLOOR ��,��[_'1 WElf D <br /> S .Zaa2 * I W STOCKTON CA 95202 <br /> SEP 2 (209)468.3420� SEP 2 5 2002 <br /> HEALIK PUBLIC RECORDS RELEASE APPLICATION <br /> J�PPLICANT r <br /> BUSINESSlAGENCY f��4 ��1 r"Or� <br /> I <br /> ADDRESS �. L"a. o <br /> PHONE r Z D ( FACSIMILE ZaQ Z <br /> Eia1 IVE"APPOINTMENT DATE TIME <br /> f { ease gI a 7 to i 0 b ,uslnes ays date F appllcation submttt q <br /> CACN ER011 T -RC EST-U9.00 FEE-- QUE T PRIAES ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7, Z <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> a <br /> Led % D <br /> C ' Lod; —n, <br /> tea„ <br /> 1d0_ C C24," 5•F; �rn <br /> S+ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> W NSDERGROUND TANK(UST)CLEANUP SITE(LOP) © HOUSING ABATEMENT C3 SOLID WASTE FACILITY <br /> V�THER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> RGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PUNT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL Q PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> 17 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEMA 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 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 appiicant 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 /> n <br />