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Jan 17 02 0b: 38p H4:'erin&Christ. r X41 r� -ou6L N L . <br /> 01.115/2002 14:42 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES 04D1,00NUMBB <br /> S ENVIRONMENTAL HEALTH DIVISION /3-5-- <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468.,3420 FAX (7,,q 1 q�-F 713 3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTL t SO f rC{Ir BUSINESS/AGENCY �✓�S T� . <br /> ADDRESsS } Sl ,1 1¢E e. S� q Ka ac r <br /> PHONE y�SL_ ��G�D#.'.r� 7 7D t'ACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 70lhusiness Clays from date of application submittal) <br /> L ,Vl r <br /> CHECK BOX TO EXPEDITE REQUEST-$89.0a FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> r <br /> FILE ADDRESS THIS SIDE EHD STAFF U91-'ONLY <br /> ` PROGRAM E LEMENTS S E!ARCH <br /> 0 <br /> W. rlt to , � , <br /> L La a5Z q k- <br /> 6'N'I e-na., La Cad,- 3S <br /> 3 q 754✓a' c G; <br /> [ot^ <br /> X46 <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q .HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VF-141C.E <br /> 0 UmbrMAGROUND TANK(MONITORINGIKEMOVAL) Gd DOG KENNEL 13 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ C14ICKEN RARCH ❑ PKG TREATt4ENT PLANT <br /> ❑ TIERED PERMITTED FACiLiTY ❑ MOTELVHOTEL 0 PUMPER TRUCKrYAR:DICHEM TOILETS <br /> ❑ TA <br /> TT00lBODY <br /> PEIRCING `, ❑ p <br /> 13 MEDICAL WASTE FACILITY ODIJSPA ❑ LAND USE APALTCAT'ONI Sl FES <br /> ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPE:IFY ABOVE) <br /> 1, List up to ten addresses in the space above, "Select the type(s)of files frorn the list abc ve•by checking <br /> . the appropriate box(es). At least one file type MUST be Selected. Fax to_(209i 464-0'431; or mail to the <br /> address indicated above <br /> f 2. EHD will notify the applicant if any I`HD files exist. An appointment for review will be c�infirmed <br /> approximately five business days but no later than ten(10) days after receipt of applictltion. The files <br /> will be held fora maximum of five business clays for review. Appointments should be e;cheduled <br /> r accordingly. a <br /> 3• A file that is actively being worked or, by EHD staff may not be immedlately available for review. A new <br /> application maybe submitted when the file is available, <br /> 4. Any file not returned in the same condition as released will be reorganized by EHDstafl at the expense <br />' of the applicant: Future file reviews by the same applicant may require a $89.00 deposit:prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications rccelved after 3:00 Pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> L <br />