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May 28 02 03: 06p :D Chesne ' 6s �9El �I?• 1 <br /> P <br /> " SAN JOAQUIN COUNTYPUBLIG HEALTH SERVICES IRE VF MMU <br /> Aru r p M <br /> • ,/ ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR MAY 2 8 2002 <br /> STOCKTON CA 95202 <br /> (209)468»3420 ENVIRONMENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PERMIT/SERVICES <br /> APPLICANT BUSINESSIAGENCYj(,(e p <br /> ADDRESS <br /> PHONE FACSIMILE -7 c- g <br /> TENTATIVE'APPOINTMENT nArc• TIME , <br /> CO) <br /> (Pleastvv71011DbusInft$-5 d f dpplicalFon subrnlllaf)CHECK BOX TO EXPEDITE RFOUESEE• IiCQUE$T PRO IN 3 BVSINE55 DAYS <br /> SIGNATURE OF/APPLICANT DATE � f�7-2-0-0 2 <br /> cFILE ADDRESS THIS SIDE el10 STAFF USE ONLY <br /> dAtu716 s.W4r �"�- 4 PROGRAM ELEMFNiS SEARCH <br /> Or ND - S DON`r 6-Tke o <br /> !jk 110 6A'5T- ANE2 uf- V <br /> n1a AFS Ert <br /> d ,puss <br /> ENVIRONMENTAL HEALTH DIVISION FILES 2 3'1019v,'Z <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 17 SOLID WASTE FACILrrY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) 0 FGoo FACELI7Y 0 SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> a TIERED PERM]•r•rEO FACILITY CI MOTELIHOTELO LIMPER TRUCKIYARDICHEM TOILETS + <br /> 0 TATTOOraoov PEIRCING I.7 POOL13PA LAND USE APPLICATION SITES <br /> f3 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> . 1. List up to ten addresses in tho space above. Select the typo(s)of films from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-013_8 or mail to f�a <br /> "r address indicated above. <br /> 2. EHD will notify the applicant if any EHp 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 maximlim of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively feeing worked on by EHD staff may not be immediately available for review. A new <br /> application niay be submitted When the file is available. <br /> 4. Any file not returned in the same Condition as released will be reorganized by EHD staff at the expense <br /> of the applicant, Future file reviews by Tho Same applicant may require a$$9,00 deposit prior to review, <br /> `TENTATIVE appointment bates mast be confirmed with EHD staff; <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> i <br /> i <br /> CONFIRMED APPOINTMENT DATE _ 'GIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVII;Y1fED� YES NO REVIEW DATE r► <br />