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if - <br /> 09/17%2003 09:36 FAX 209 9480521 IZ1002/004 <br /> DATE Rr-CI6VM . <br /> aMo Loc r<uKaEt <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> r; 'F-NVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,'THIRD FLOOR <br /> SEP 1 7 2003 STOCKTON CA 95202 lqq7 <br /> (los)4683420 <br /> r I,j.I-,OWEN1 E��T�'PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ,=L` }I�P(.(�C _BUSINESSIAGENCY t-�.��,moi f-r--Lz <br /> ADDRESS <br /> PRONE O`) 3L15:_ ?-09 FACSIMILE U Z.i <br /> TENTATIVE*APPOINTMENT DATE -3�-3 TIME r Zc10 <br /> (Please 21ve 7 to 10 business-days from date of applleatlon subm tta)) <br /> CHECK BOX TO EXPEDITE REQUEST•# 7.00 F —REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> i! <br /> SIGNATURE OF APPLICANT DATE 1 vD <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY t L <br /> PROGRAM ELEMENTS SEARCH <br /> 1. I i v A_ <br /> 2 z GR I A- S 7- �, 3 <br /> P_rL-P%'t4E AJFr. L f 1+ <br /> M G (] S l . L'r I� <br /> L 1 It Ir <br /> �r tl <br /> Ir (r <br /> Ip 51d LI 1� [ r <br /> t,�rCl ��._t.�js' �'-F'r`"1�'f•L.' i i rCy:-- ;_t•�r�_ �,y.;l <br /> ENVIRONMENTAL HEALTH DIVISION FILES C,'•.�_,tl,:f (/l,,/�I <br /> CSb UNDERGROUND TANK(UST)CLEANUP SITE(LOP) L`] HOUSING ABATEMENT SOLID WASTE FACILFTY r'' 'I�"i L'• --��y j..rt!`;-"r <br /> I? OTHER CLEANUP SITE(NON-LOP) 4 FOOD FACILITY C1 SCUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONrroRINGIREmovAL) ❑ DOG KENNEL N DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IR PKG TREATMENT PLANT <br /> C1 TIERED PERmrYTED FACII1rY ❑ MOTELIHOTEL d PUMPER YRUC tYARD1CHEM TOIL.€TS <br /> C3 TATTOOIBODY PEIRCING a-PdOLiVXa'LAND USE APPLICATION SITES <br /> E3 MEDICAL WASTE FAciLn'y E3PUBLIC WATER SYSTEM 10 OTHER(PLEASE SPECIFY ABOVE) <br /> '1. 4 List asp 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. ax to 209 464-01113 or mall to the <br /> address lndica.tad above_" <br /> 2. EHD will notify the applicant if any EHO 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 he 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$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Appilcatlons received after 3:00 pm will be processed the next business day. <br /> q <br /> CONFIRMED APPOINTMENT DATE TIME,, <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> R MEWED YES NO REVIEW DATE <br /> k . <br />