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SEP 16 '03 09:43AM CO'' ID ENGINEERING P.1/1 <br /> EHD LOG NUMaER <br /> DATE RECEIVED SAN JOAQUIN COUNTY. <br /> ,NVIRONMENTr'AL,HEALTH DEPARTWNT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 \ ,_ <br /> (209)468.3420 Fax: (209)464-0138 Web: www.co.san-joaquin-ca.uslehd <br /> gUBLIC RECORDS RELEASE APPLICATION <br /> APPLICIWT: ` BUSINESSiAGENCY: <br /> ADDRE89: lO Q <br /> PHONE: <br /> 937'" L -FACSIMILE:_a —g3 7" ZZ7 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Piaw4 sitaw 10 business days from data of application submlttaq <br /> CHECK BOX TO EXPEDITE REQUEST'S 00 FEE QUEST PR ED IN 3 BUSINESS DAYS <br /> DATE 6 D <br /> SIGNATURE OF APPLICANT Department Use only <br /> UNIT <br /> OLKADDR9811 <br /> ❑ Unit 1 <br /> �. ,.: 4 ❑ Unit 2 <br /> D Unit 3 <br /> Ckv <br /> Unit 4 <br /> 7. SIRl1 <br /> Cil <br /> a. Ckv ❑ UnitSlow <br /> 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> !l AROUND TANK(UST)CLEANUP SITE(LOP) D E3 SOLID WASTE FACMM HOUSING ABATEMENT 0 OLID <br /> 13 <br /> C1 OT#M CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ DAIRY <br /> t3UN UND TANK(00WITORINGMEMOVAL) a DOG KENNEL E3PKG TREATMENT PLANT <br /> C3 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH r3PUNPERTRUCK/YARDICHEMTOILETS <br /> O TIERED PERMn7ED FACILITY ❑ MOTEt1HOTEL ❑ LAND USE APPLICATION SITES <br /> CIi'O <br /> TATOIRODY PIERCING O A <br /> El MEDICAL WASTE FACILITY ❑ OTHER THER(PLEASE SPECK <br /> List up to ten addresses in the space above. Select the type(s)of files front the list above by Checking <br /> 1' <br /> the iipprapriate box(ss). <br /> At least one file type MUST be selected. Fax to 2091484-0139 or_ttnail to t18 <br /> addreI indicat d-ah <br /> 2. END will notify the applicant if any EHD files exist An appointment for rwiew 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. be immediately available for review..A new <br /> 3. A tie th*t is actively being worked on by END staff may not <br /> application may be submitted when the file is available. <br /> 4 Any file not returned in the some condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> g. -TENTATIVE appointment dates must be confirmed with END staff. <br /> g Applications received after 3:00 pm will be processed the next business day. <br /> CO�FIRM{ D..d►PPOII�7MENT•DATE <br /> TIME <br /> DATE CONFIRMi.D ' P,HO,NE FAX <br /> INITIALS <br /> RE1IfEWED YES NO REVIEW'DATE, " <br /> .n�oo3 <br />