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05 / 09 / 2003 14 : 40 9255517464 - ENVIROFORENSICS PAGE 197. / 01 <br /> qOATS RECEI D <br /> :No Un HUM <br /> M SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �j) <br /> _ 304 EAST WEBER AVENUE, THIRD FLOOR <br /> r\Y 0 F9 111, STOCKTON CA 95202 <br /> (209) 468-3420 <br /> I � a <br /> PNBLIG RECORDS RELEASE APPLICA'fiOAl <br /> APPLICANT <br /> ADDRESS <br /> PHONE Lm- SS I - `77rJ 2_ FACSIMILE <br /> TENTATIVE* APPOINTMENT DATE At <br /> 1�L Icy JS''�'t TIME JCt ;�::"��J,� -J) _ I �j .� 3 <br /> (Please give 7 to 10 business tliye rmm data of application submittal) ' , „ L <br /> CHECK 80XT0 EXPEDITE REgUE3T - 539.Oe EOUES"r PROCESSED IN 3 BUSINESS DAYS LAX■ ' T �� q <br /> SIGNATURE OF APPLICANT -- DATE ���_"'I • 9 "0 ', <br /> FILE ADDRESS THIS SIDI :EIID 91 OF USE ONLY <br /> PROGRAM I::LENH-:N7!7_SEARCH <br /> ,µa. ..l OS <br /> -II Gukn�kt - -- <br /> 1 '-- - - -- <br /> J ENVIRONMENTAL HEALTH DIVISION FILES <br /> m JINDERGROUND TANK (UST) CLEANUP SITE (LOP) ElHOUSING ABATEMENT Cl SOLID NASI li FAC:IIJTY <br /> �THER CLEANUP SITE (NON10P) <br /> 13 El <br /> FACILITY 0 SOLIDWAST G VEHICLE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL EI DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKC: TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL EI PUMPE R TRUCK/YAIiD/CHEM TOILETS <br /> ❑ TATTOOIBDDYPEIRCING ❑ POOU37A - CI . LAN D USE A7'PUCA:nDN SITE$• <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <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 -L0��34-(1171& or mail to the <br /> address_ indicated <br /> 2. EHD will notify the npplicant if any EHD files P_xlst. An appointment for review III be confirmed <br /> approximately five business days but no later than ten (10) days after rel:efpt of application. The files <br /> will be held for a maximum of five business days for review. Appointme,its 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 reorganWid by EEID staff at the expense <br /> of the applicant. Future file reviews by the Snme applicant may require a $119 .00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be contlrmed with EHD staff, <br /> 6. Applications received after 3 :00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br />,I DATE CONFIRMED PHONE FAX 1141TIALS __. _ <br /> REVIEWED YES NO REVIEW DATE <br /> ESRD ae.saaoa — <br /> aenooa — <br />