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0/2003 12:40 FAX 209 9480en � � 0002/0022 <br /> r <br /> DATE Mewo <br /> _:` j i ', FM wa N M ER- <br /> „ SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMEWAL HEALTH DIVISION <br /> U E G u 0 ZOO-^, 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STQGKTON CA 95202 <br /> (289)468-3420 3q <br /> w , ' `0.1,:f-,7` PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 11 l r+l BUSINESSIAGENCY L� 4Q�t-� 1 <br /> ^U P y <br /> ADDRE33 'ZFOT S' M Y LMLA—Z j p �"�� <br />[ PHONY 1145' FACSIMILE _-- Y 9 - <br /> TENTATIVE'Ap"mTmENT DATE ! R fa TIME GD <br /> (Please give 7 to 10 business days frons date of applicatlaa submittal) <br /> r <br /> CHECK BOX TO EXPELITIE RF_QUEST.SaTao FEE= EST PROCESSED IN 3 BUSIHm DAYS <br /> SIGNATURE OF APPLICANT DATE o` <br /> FlIS ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGPJW ELEMEM SEARCH <br /> C A <br /> 9-4 <br /> 3 <br /> C► l0 t• �ti I' �c <br /> l <br /> \I 5 VLDL, <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> IF UNDERGROUND TANK(VST)CLEANUP SM(LOP) 13 HOUSING ABATEMENT )9 SOLID WASTE FACILITY <br /> tR OTHER CLEANUP SITE(NON LOP) o FOOD FACILI Y G 5 O WASTE VEHICLE <br /> CP UNDERGROUND TANK(ROMORINMEMOVAL) 13 DOG KENNEL DAIRY <br /> El HAZARDOUS WASTE CENEMTOR D CHICKEN RANCH PKG TREATMENT PLANT <br /> E3 TIERED PERmnTEDFACWTY ❑ MOTELIHOT'EL PUSAPE.RTRUCrUYAMMEMTOILEM r <br /> G TArr0omODY PoPaNG d•PooI1sPA "-­ IRF LAM USE APPLICATION SI!>wsi <br /> Y <br /> (3 MEDICAL WASTE FACUA lar PUBLIC WATM SYSTEM 17 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the W above by checking <br /> the appropriate boges). At least one file type MUST be selected. ax to 209 4 -0138 or naafi to the <br /> address indicated above.. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for mview 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 maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by F-Ho 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 4xpen5e <br /> of the applicant. Future file reviews by the same applicant may require a$6T.00 deposit prior to review. <br /> 6. 'TENTATM 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 /> DATECONFIRMED PHONE FAX INITIALS <br /> RF1/IPW1= 1 YFG Wn RFVIFW noTF <br />