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09/17/2003 09:37 FAX 209 9480r't (A003/004 <br /> 10G Nuuo[R <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION _ <br /> SEP 1 7 2003 304 FAST WEBER AVENUE,THIRD FLOOR ENVIFiO[gMENI HEALIH STOCKTON CA 95202 lqq,$ <br /> °FR��ITISER iICES (209) 465-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT k GVH 1 tJ >lm U�i, BUSINESS/AGENCY <br /> ADDRESS /�,�7.5, r- <br /> PHONE (fQ?--!' fdJ2 /FFAC51MILE 67 —0 <br /> TENTATIVE'APPOINTMENT DATE_ % /( 0 TIME <br /> (Please Ulve T to10�ays from date of applicatlon submittal) �_ 7 <br /> Q CHECK BOX TO EXPEDITE REQUEST-$877 0/O FFE[ QUEST PROCESSE�Yt 1] BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / L�•tl J� -- DATE <br /> FILE AOS-D-"RE;S`STHIS SIDE EHD STAFF USE ONLY U <br /> PROGRAM ELEMENTS SEARCH <br /> It <br /> I DO r4. <br /> — <br /> me Hw 9 s-1113c+L+v,J <br /> 1, >�1P�J <br /> 3 tto <br /> I-IS4b N. w,c oa wn. • � �, , <br /> 00 0 u „ <br /> oxgg .I .' „ „ CAj <br /> —3- 50 -+ GO SPOD /n iV <br /> 1 I�J� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M 5OLID WASTE FACILITY <br /> P OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY - ❑ SOLID WASTE VEHICLE <br /> Et UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL - A DAIRY } <br /> W HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH F3 PKG TREATMENT P <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> O YATTOOfBODY PEIRCING ❑ POOL/SPA - • = LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBuc WATER SYSTEM ❑ OTHER(FLLASE SPECIFY ABOVE) <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 (209) 464-0138 or mall to the <br /> address Indicated above. <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 receipt of application. The tiles <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 may 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 the same applicant may require a $87.00 deposit prior t0 review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next buslness day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO _ REVIEW DATE <br />