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U2704/02 MON 15:58 Fri 209 0621 KLE1NP LDEK <br /> DATE RECEIVED EKD LDC NUMBER - <br /> SAN JOAQUIN COUNTYPUBLiC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> IC ,► , 304 EAST WEBER AVENUE,THIRD TLOOR ri <br /> F <br /> IY Y I:; 1 '+._ ;: i 3Er �.I Ii STOCKTON CA 95202 <br /> :€ (209)469-3420 <br /> Q9 PFR=S- Am FILd UDLIC RECORDS RELEASE APPLICATION <br /> APPLICANT :E.`1 /�tary�Z BUSINESSIAGENCY � ,` <br /> ADDRESS <br /> PHONE Iq 49 q S FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE �d a_ Tim <br /> (Pleasa give 7 to 10 business days from%e of sppli ation submittal) <br /> l /C!/Tss . <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE REQl1 RC1C > IN U5iNE55 DAYS <br /> SIGNATURE OF APPLICANT DATE �y O <br /> FILE ADDRESSTHIS SIDE AHD SfOF USE ONLY <br /> pROGRAM ELEMENTS SEARCH <br /> Y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) .0 HOUSING ABATEMENT /C-SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) C3 DOG KENNEL 0 DAIRY <br /> ,,{HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH D PKG TREATMENT PLANT <br /> X TIERED PERMiTTED FACILITY ❑ MOTELIHOTEL .-. 0 tp)use Appu ATION EM TOILETS <br /> 0 TATTOOIBODY PEIRCING 0.POOLISPA LAND USE APPLICATION SITES <br /> 0 MDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEMA O OTHER{PLEASE SPECIFY ABOVE} <br /> E <br /> List:up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to209 464--0130 or mail to the <br /> address indicated <br /> 2. EHD will notify the applicant if any EHD files exist. An appotntment for review will be confirmed i <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 EHD staff,may rlpt be'Immediately available for review. Anew <br /> application.may be submitted when the file a available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prier to review. <br /> 5. -*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 /> PHONE FAX INITIALS <br /> DATE CONFIRMED <br /> FiE1fI)`WEC) <br /> YES NO REVIEW DATE <br /> k <br /> Vigo 14 owurmu <br />