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09/17/2003 09:37 FAX 209 9480621 _ 0041004 <br /> nSAN JOAQUIN COUNTYpUBI.IC HEALTH SERVICES <br /> �.9 _It ,�Icf,CC ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 7 2003 STOCKTON CA 95202 ' <br /> (209)468-420 <br /> NVIRUNM NT uwau PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT ill BUSINESStAGENCY k- <br /> ADORE" <br /> PHONE ZC7a1 FACSIMILE j26 Z <br /> i LL <br /> TENTATIVE"APPo1NTMENT DATE_ lG��o TIME /Z oL7 <br /> (Please glue 7 to 10 business days from date of appllcaBon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$47.o0 QUEST P ESSED IN 3 BUSINESS DAYS t <br /> SIGNATURE OF APPLICANT DATE cv��z <br /> FILE AdDRESS THIS SIDE EHD STAFP USE ONLY <br /> PROGRAM V EMEN73 SEARCH <br /> 14 0Z RJ <br /> n <br /> 1� . , <br /> 11 r/ <br /> ,. r. <br /> 1< <r <br /> L7— <br /> Is <br /> QL <br /> U ! t <br /> `A C:� tf�,�;� PIK, <br /> ENVIRONMENTAL HEALTH DIVISION FILES _ 3- ��•, ,,;;,; :; ✓den <br /> �AUNDER1GRO=TANK(LIST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT is SOLID WASTE PACiLlT1f <br /> IP OTHER CLEANUP SITE(NON4LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> §1 UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL IN DAIRY <br /> �7 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ® PKG TREATMENT PLANT <br /> O <br /> TOM PERMITTED FACILITY O M0TEL4{0TgL C3 PUMPER TRUCk/YARDICHEM TOILETS <br /> ❑ TATTOOMODYPMCING 13•1-60LAf A - is'LAND USE APPLICATION BITES <br /> ❑ MEDICAL WASTE FACILITY 0 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(east one His type MUST be selected. Fax to{209 46__ 138 or m it tp the <br /> address indicated Above.. <br /> 2. 1_HD will notify the applicant if any EHO 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 EHO staff may not be immediately available for review. A now <br /> appllcation may be submitted when the file Is kvallable. <br /> 4• Any file not returned In the same condition as released will be reorpanized'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 /> s• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 5;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 />