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1_/ <br />V <br />MEJ <br />F K ti --�d101 N >k tNV INUNMt.N I AL HLC PACE 01 <br />- -- <br />JAN 1 5 2003 <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />30.4 EAST WEBER AVENUE, THIRD FLOOR <br />STOCK -FON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY I Sl <br />PHONE D ` y 1 ' U� FACSIMILE _ I O { 3 q-' / P'7 D <br />TENTATIVE' APPOINTMENT DATE TIME Mr t r rl I it d <br />(Pleas* give 7 to 10 busliness chys from dot• of application submittal) Uill7J CHECK BOX TO F;(PEDITE RE EST - 589.00 FEE ECIUEST PROCESSED IN 1 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE I K D 3 <br />j .. <br />��, <br />. •21 <br />�1• 11 a 11 ,' i e,,,a, ',�.. , �°����,�� <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MON ITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br />O HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FAGILI7Y' O MOTELIHOTEL ' IO PUMPER TRUCK/YARD/CHEM TOILETS <br />CO 7AT70018ODY PEIRCING ❑ POOLAPA ❑ LAND USE APPLICATION SITES <br />0 MEDICAL WASTF- FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY A60VE) <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. Pax to (209) 464-0138 or mai) 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 files <br />will be 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 relearad will be reorganized by EHD staff at the expense <br />of the applicant f=uture rile reviews by the same applicant may require a $89.00 deposit prior to review. <br />S. "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 />lREVIEWED YES NO REVIEW DATE <br />TO/TO*d 82TOP9176e(ft Ul U -J OU- t��� •�� <br />Op <br />