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05/03/2002 11:03 FAX 209 948 0621 KLEINFELDER (r..�. 17j001/OOP <br /> Y✓ fir/ eno UMWZ <br /> g <br /> MTF aE UVFM SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ] <br /> ENVIRONMENTAL HEALTH DIVISION iJ/� <br /> 3 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR STOCKTON CA 95202 c <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATI0N2 <br /> APPLICANT 7� l C i.✓ t l I U�+ BUSINESSIAGENCY^V L C' f fT L 10 <br /> ADDRESSC <br /> l e f <br /> PHONE ZO 7 L 4g Z� (34] FACSIMILE �iVcl �(SCf C `�•Z I <br /> ao. T <br /> TENTATIVE-APPOINTMENT DATE S i`IS I TIMEtt <br /> (Please give 7 i us' es�str date of application submittal) i <br /> I] CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUE PRO IN 3 BUSINESS DAYS L <br /> SIGNATURE OF APPLICANT DATE 5 I _ <br /> FILE ADDRESS THIS SIDE EHD STAFF SSE ONLY <br /> PROGRAM ELEMENTSSSUIRCH � <br /> I <br /> N J it 35,24 f <br /> AZr 'a SIC vI✓C�nIC <br /> I <br /> '1 nHc.Ti qv N✓ <br /> i k <br /> i <br /> h <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING A13ATEMENT - 0 SOLID WASTE FACILITY <br /> r-VCUNDERGROUND TANK{UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE - <br /> iT-bTHER CLEANUP SITE(NON-LOP) 0 DOG KENNEL ❑ DAIRY FI <br /> LI UNDERGROUND TANK(MONRORINGfREMOVAL) 0 CHICKEN RANCH 0 PKGTREATMENT PLANT <br /> 0 HAZARDOUS WASTE GENERATOR 0 MOTEL/HOTEL 0 PUMPER TRUCKPIARDICHEM TOILETS <br /> 0 TIERED PERMITTED FACILITY 0 POOLISPA ' - " 0 LAND USEAPPUCATION SITES k <br /> 0 TATTOOIBODY PEIRCING 0 PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 13 !`r <br /> MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) <br /> of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the f <br /> address indicated above. y ointment for review will be confirmed <br /> 2.. EHD will notifytheapplicant if an EHD files exist. An ap) y P application. The files <br /> approximately flue business days but no later than ten (10 days after receipt of app <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 maybe submitted when the file is available. <br /> q. Any file not returned in the same condition as released will be reorganized by <br /> 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 /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. fj <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> t _ <br /> REVIEWED YES NO REVIEW DATE <br />