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09/17/2003 09:36 FAX 209 9488062-1 002/004 <br /> OATS RECEpa-o A `f glib LQG NUM UEA <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> �{—r-' ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 7 2003 STOCKTON CA 95202 fqq7 <br /> (209)468-3420 <br /> NWENI HEWHpUBLIC RECORDS RELEASE APPLICATION <br /> P ;•A yM I <br /> APPLICANT t�L\� SW C,( :.� BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE ZO`� 1 C7LiFACSIMILE ?-69 1b N S IL)6 Z I <br /> TENTATIVE'APPOINTMENT DATE TIMEfg 17-CiC <br /> (Please give 7 to i0�ness days from date of application subm ttal) <br /> CHECK BOX TO EXPEDITE REQUEST•; 7.06 F -REQUEST PROCESSED IN 3 BUSWESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 3 E ib A 3 <br /> 2 -Z tJ CA LA fbal I R- T. t �� 3 <br /> C t It t, <br /> t t L 5 <br /> L0 S(o " <br /> ULC!" <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> 1% UNDERGROUND TANK US CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 1�11 SOLID WASTE FACII.rTY <br /> R OTHER CLEANUP SrrE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL (0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL E3 PUMPERTRUCKIYARDICHEMTOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA la LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBUC 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 mall 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 tiles <br /> will be held for a maximum of rive 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 revlew- <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 />