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02/18/2004 11:29 FAX 209 9480 Q002 <br /> EHO LOG NUMBER ; <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SEB s 200 304 EASE'WEBER AVENU5,THIRD FLOOR <br /> STOCKTON CA 95202 �, <br /> ENVIRONMENT H> ETH (zos)4ss- 42a <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION C=) <br /> Ile <br /> APPLICANT._ I VA 4U]tR . S •--SUSLNF-SSIAGENCY 1. 1 . 1 £L.'ia .y l C• _ '"' <br /> ADDRESS <br /> PHONE CmA ( FACSIMIL S !0 47) <br /> TENTATIVE*APPOIMENT DATE 7— <br /> TIME <br /> j (Please gt"T to 10 buslness days frown data of appg4mdan submittal) <br /> CHECK BOX Td EXPEDI'M REQUEST-SU,00 FEE-REQUEST PFtOCE ED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> Z <br /> I <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �L <br /> I <br /> a l u v 7a�7/2 <br /> M <br /> Ki; k fr M k <br /> I <br /> I <br /> I - <br /> i w <br /> }'� Y <br /> .'ENVIRONMENTAL HEALTH DIVISION FILES <br /> O HOUSING ASATE1Vl�T SOLID WASTE FACIt�'iY <br /> er UNDERGROUND TAMC(UST)CLEANUP SfrE(LOP) <br /> El oTi9FR cLEANU4 SrrE(MON-LOP) o FOOD-FACILITY SOLID WASH VEHI <br /> • Qd UNDERGROUND�'AKK(MONWORIt�IOMMOVAL) p DOG KEHNEL lea DAIRY :-�' 4 <br /> Vr F;AZAM)OUS 114lASTE GENERATOR a CHICKEN RAHCM Ip'PKG TREATm9NT PLANT <br /> ' 13 TIERED PERI n-ko FAaLrrT a MOTELIHOTEL , 0 PUMPERTRUCKrYAFXMHW TOILETS <br /> 0 TATYOOIBQDY P)IRONG Q'POOLJSPA LAND USE APPLICATION srres <br /> 0 MEDICAL WASTE FACILITY W PUBLIC WATER SYSTEM 9'UMERp LEIMSE SPECIFY AgGHE) <br /> I <br /> to ten addresses in the space above- Select the type(s)of files from the list above by checking <br /> 1_ List u;J <br /> the appropriate box(es). At least one HIS type MUST be selected. Eaxto(20p)46-46-0138 ar mai!to the <br /> address indicated $ ove.. <br /> Z EHD will notify the applicant N any EHD files exisL An appolntmeht 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 beheld 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 aVallable for review. Anew <br /> application may be submitted when the file Is available. 4 ` <br /> 4. -Any fill not returned In the same condition as released wilt be reorgantred'by EHD staff at tits,expense <br /> of the pplicant Future file reviews by the same applicant may require a$87.00 deposit prior to review. f <br /> 5. *TENT TiVE appointment dates must be confirmed with EHD staff. <br /> 6. Appu ttions received after 3:00 pm will be processed the next business day. <br /> II <br /> CONFIRMED POINTME14T DATE TIME.., <br /> ,DATE CONFIRMED PHONE FAX INITIALS <br /> f <br /> --..�.... I u*-r. •rn nc%nrw naTr <br /> l <br /> • I <br />