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06/1_0/2003 08:57 FAX 209 9480621-'-" 121002/0 Q3 <br /> :0(kmFX-C C;i I ; _ WO LOG IIIUEII <br /> !y { ( !.+!i � SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ), <br /> ENVIRONMENTAL, HEALTH DIVISION ' <br /> ,JUN 10 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKT'ON CA 95202 j <br /> (209)4 68-3420 (( )] <br /> v </ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ' APPLICANT TG JSr S—A A-? a. BUSINESSIA(iENCY - <br /> J; ADDRESS S7- S-TD 0G-i-it71J IRS' 017' <br /> PHONE 2 ocj-R i•1*3- 1 4 S ---- FACSIMILE_ <br /> TENTATIVE*APPOINTMM- T DATE 61,201,23 71ME V!-t2-L1> <br /> — <br /> (Please elve 7 to 10 business day:,from data of appllcaflon submim) rq74 <br /> CHECK BOX TO EXPED{TE REQUEST-S ,q0 F -REQUEST I•'ROCSSSED IN 3 BUSINEUS DA(,S <br /> SIGNATURE OF APPLICANT DATF <br /> FILE:ADDRESS THIS SIDE FEED SS'U1FF U5E ONLY 1' ,��` <br /> +. PROGRA t.4 ELEIJU i?M S�iCH m�✓'1 oi/ <br /> ZZ ; IQtf ors ¢.D. R.Poll, CA r 9�3 ate_ — - I' •� <br /> 'Ly <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 4A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C7 HOUSING ABATEMENT 1P SOLID I(VAS".'E FACIL Y <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAf ALrTY (21 SOLID I(YAa^ E VF:li1= <br /> UNDERGROUND TANK(MONITOFRINGMFMOVAL) ❑ DOGS KENNEL 8 DAIPY <br /> �i St HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH W PKK T11EAT tIEW PLAt{r <br /> (P nEREDPEwn-TEDFAGLITY ❑ MOTELAJiML ❑ PUDIPE:IRTF(UC1KIYARDfCHEMTOILMala <br /> C3TATTO=ODYPE RCING C1•POOUSP;' - la'LAbV USEr1PPUC.AT1CN SM3 -5-02Q <br /> ❑ MEDICAL WASTE FACIL MY �L PUBLIC WATER SYSTEM ❑ OT1--R(PLC ASE SPFQFY AHOVE9 �ICelJy/If <br /> 1' 1. List up to ten addresses In the space above: Select the type(s)of files from the list abovi by cheumog <br /> the appropriate box(es). At least one file type I'+!EUST be selected. fax to,�22J9 64-0138 or m71I1 tCloth <br /> address indicated above. <br /> Z. EHD will notify the applicant if any EHD files exist An appointment for review+vill be confirmed <br /> approximately five business days but no later than ten('t.0)days after re relpt o�:application. 'Che file a <br /> will be held for a maximum of five business days for review. Appointment!i should be sched(ded <br /> BCcordingly. <br /> {. 3. A file that Is aOVely being worked on by EHO:;taff-may not be IrnmedialMyi av;'liable for review. Anew <br /> application may be submitted when the rile is a.vallable. � <br /> 4. Any file not returned In the same condition as released will be reorganIz(Id'by FFD staff at thl?! elcpense <br /> of the applicant. Future file revleWs by the sante applicant may require a$137,4'1 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with F-HO staff. <br /> 5. Applications received after 3:40 pm will be pro.essed the next business doy. <br /> CONFIRMED APPOINTMENT(DATE <br /> DATE CONFIRMED PK DIVE FAX I TNrTI(1L:i <br /> RENiEvYED YES NO RFrIEW DATE <br />