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FROM +CTE—Esc. � FAX N0. : 7605460328 Jun . 17 2002 11 : 36AM P1 <br /> _ _y AIS 11CLI;IrtiJ ��V 9408 <br /> ENVIRONMENTAL FPALTH PAGE 01 <br /> a SAN JOAQUIN COUNTYPUSLIC HEALTH SERVICES Pyla 4uG Nl McRR <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> v 304 EAST WEBER AVENUE, THIRD FLOOR I <br /> C) r' J ! '. ' i 7 ' 138 sT(209) ase 3A42oaoz o <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ADDRESS T __ �u� Tic( _• EUSINESSIAGENCY dorg4rtjchO I " <br /> - <br /> ADDRESS 2-Y ={ Vi„e e5�• � celyn <br /> ° �! ATE - G EScancl ; do C & 12- Oz <br /> PHONE 7Gtl 71( b - `(95SFACSIMILE 71D - 7% ?06 . . <br /> o 11 <br /> TENTATiVE• APPOINTMENTOATB 62.5OZ - TIME 7 : 00 ' <br /> (Please give Y to to bTalne a day�m ddi�e o application submittal) <br /> IWAt <br /> © CHECK BOL( TO EXPEDITE ReQUEST _ REQUESTP OCEgSN 9 BUSINESS LAYS <br /> SIGNATURE OF APPLICANT � s DATE <br /> F+LE gODRE55 THIS SIDE RHD srAFF use ONLY <br /> MIMI WE MEN PROGRAM ELEMENTS SEARCH <br /> 6 or o S r <br /> 2 � SOI: OF <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE -(LOP) M HOUSING ABATEMENT L1 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) In FOOD FACILITY 0 SOLID WASTE VmcuC <br /> UNDERGROUND TANK (MONrrORINGIREMOVAL) in DOO KENNEL t7 DAIRY <br /> rl HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL M PUMPER TRUCKIYARDJCHAM TOILETS <br /> ❑ TATTOOMODY pLIRCING Q PGOUSPA LI LAND 119E APPLICATION Sires <br /> ❑ MEDICAL WATTE FACILITY ❑ PUBLIC WATER SYSTEM b 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. F <br /> gt)dross indicated aboveax to 09 464-0138 o t <br /> 2. EHD will notify the applicant If Any END 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 END Staff may not he Immediately available for roVIaW. A new <br /> application may be submitted when the file IS available. <br /> 4. Any file not returned in the same condition as releastid will be reorganized by END staff at the expense <br /> Of the applicant. Future file reviews by the same appttaant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be Confirmed with END staff. <br /> e. Applications rocolved after 3:00 pm will be processed the next business day. <br /> Pill I <br /> CONFIRMED APPOINTMENT DATE . TIME <br /> DATE CONPIRM5b PHONE FAX INITIALS <br /> R---'Xh 1NHD YES NO REVIEW DATE <br /> �,.. <br />