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06/1.•7/2004 08:44 F.A% 209 948' t 2002 <br /> «`®[ I— ! EMO LOG NUMBER LU! SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 17 Z004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 59 <br /> ENVIRONMENT HEALThi (los)468-3420 <br /> p1 jSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT V-Sy(1 1 S1wL.Fi�, BUSINESSIAGENCY <br /> ADDRESS 2`O L 1 r. & '{fi'n-l.�- T. �7 -b� <br /> PHONE `"'b- //FACSIMILE ol`�b ' 06 '►-1 <br /> TENTATIVE-APPOINTMENT DATE 4)7y1dL{ TIME �JL' <br /> (Please give 7 to 10 business days from Gate of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST �OO —RE4U T OCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> 6 !}r d G •�Sl <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> pit — Ici-00 it `• <br /> ' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> OF UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT I SOLID WASTE FACILITY <br /> 0 FOOD FACILITY O SOLID WASTE VEHICLE 1 <br /> OTHER CLEANUP SITE(NON-LOP)FU ❑ DOG KENNEL 0 DAIRY PLANT <br /> UNDERGROUND TANK ENERAT RINGI0.EMOYAL) 17 CHICKEN RANCH - 0 PKG TREATMENT ARL)IC ` <br /> Q HAZARDOUS WASTE GENERATOR ❑ MOTELh10TEL 0 PUMPERTRUCKlYARD/CHEM TOILETS \Un <br /> O TIERED PERMITTED FACILITY O POOUSPA ., _ 01 'LAND USE APPLICATION SITES I <br /> MEDICAL WAS PEIRCILI 5b PUBLIC WATER SYSTEM CI OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY <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. Fax to !2091 4MOLMail tot e <br /> address Indicated bove.. <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 reipt thou dOf pbe sched ledli-,ation. The files <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A net <br /> application may be submitted when the file is avallable. ns <br /> 4. Any file not returned In the same Condition as released <br /> will be r rg iroza d by deposit prior staff at the ere ens' <br /> of the applicant. Future file reviews by the same app May require <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 <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />