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03/04/2003 10:58 464013 ENVIRONMENTAL R - PAGE 01 . <br /> ....... ..... <br /> DID IAG YUmban <br /> �� � i$AN JOAQUIN.COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 1 <br /> BAR. 0 4 C0�� V 304 EAST STOCK?ON CA 9S 02 THIRDWESER AVENUE, FLOOR <br /> (209)468-3420 [13 7 <br /> rT?C� <br /> ll ` r L �I:iPUBLtC RECORDS RELEASE APPLICATION' i1 f- w:,7 <br /> A�� <br /> .Ic�APPLICANTDH'N IF('Lr; `_�S( 1!✓I:(�ON RUSINESS/AGENCY Ar L �'SsSLC•(A�T�'S�/NG- W <br /> ADORE.55 .��OCD GyI SgO/Y2E�� /r7/IOG�7/fI/�/YGJy� <br /> PHONE l 9Z&)33 /'OS// / ��7 FAC,SIAgE�4E r'?A ,33 9 O J Q y <br /> TENTATIVE"APPozNTMENrnKr£ :T I ILf rff 7, 17.003 TIME (Z./lU f'3�• <br /> (PIC""give 7 lv 1b 6wIna5S daTs tram dila of appllwllon 3abmllial) <br /> CHECK BOX TO F7(PEDITE REQ T-50.1.00 FEE-RECUESTPROCESSEOIN30USItIESSUAYS1 I/ ' <br /> SIGNATURE OF APPLICANT,-2L) - vM <br /> {�! � - - - DATE' <br /> FILE ADDRESS THIS SIDE END STAIV USE ONLY <br /> PROGRAM ELEMan S SEARCH <br /> 7DO Wr I3LYi 5 q6 I il17 51 no <br /> 7;72-jQ G GYi S 9S w�Fn^7- <br /> 27D <br /> e0&N7W Gu/ BL-v01 4,z Crf- 3 ✓ y __ <br /> G40acv S Cercz^/� tick c v I I OL t <br /> 7S 8c.vf Cr99s <br /> eIZIC cSTDC c7br✓ COP e- i • ;� -- -----� <br /> ENVIRONMENTAL HEALTH DIVISION FILES ' ) <br /> W UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) V FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGfREMOVAL) CT DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMTINT POINT <br /> Q TIERED PERWTTED FACTLITY 0 MOTELMOTEL tl PUMPER TRLK:KIYARolCHEM TOILETS <br /> 0 YATTOOMODY PCIRCING 0 POO"PAT.�LAND USE APPLICATION$ST-S <br /> O MEDICAL WASTE FACILITY O OTHER(PLEASESPECIFYABOVE) <br /> 1. List up to ton addresses in the space above. Select the type(s) of Flas from the list above by ohecking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209)413.4.0138 or mail to the <br /> r.» address indicated above. <br /> 2 EHD will notify the applicant if any EHD files exist An appointment for review Kill be confirmed <br /> approximately five business days but no later than tan(10)days after receipt of application. The fines <br /> will be held for a maximym of live business days for ravlow. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that 3s actively being workod on by EHD staff may not Immedlatety availob tc for revievr. Anew <br /> applicatlon may bo submitted when the file Is available. <br /> .4. Any rile not returned in the same condition as relaased will bit reorganized by EHD staff at the expense <br /> of,the applicant. Future rile reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EH0 staff. <br /> . 6. Applications rnccivao after a:Oa pen wIIT be processed the next business day. ) • <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED . PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE ^' <br />