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/li 2UU3 UU:37 Id1 20U 9,180621 1�j004/004 <br /> DATE REGENFi1 EHU LOG NUMDEA <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> Ir —C I��;I�r- �l ENVIRONMENTAL HEALTH DIVISION <br /> 304 LAST WEBER AVENUE,THIRD FLOOR <br /> F P 1 7 2003 STOCKTON CA 95202 I <br /> (209) 468-3420 <br /> I�;V�Ruf!(VIEf�1T i�EAf 1 PUBLIC REG_ORDS RELEASE APPLICATION_ <br /> A.'PUCANT—__t-1�)I �i P�P�.F�� _—BU5INES5IAGENCY K <br /> ADDRE55 p <br /> PHONE ZC1 GL{`D r3'( ( 5 _FACSIMILE �(7 �}c{� p6 z J <br /> TENTATIVE"APPOINTMENT DATE `7 �Z �� 0 TALE <br /> (Please Ulve 7 to 10 buslnoss days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-587.00 F - QUEST P CESSED IN 3 BUSINESS DAYS ' <br /> � L <br /> SIGNATURE OF APPLICANT DATE 7l/ 7L/O�D <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Lq O T L �' II <br /> a J <br /> ILl 1 <br /> "sLf 2 N . wtLNOti1 wA1) � �7 <br /> 7 E 11 � <br /> ASL-ALA- -cc y. yg �'3 - yY&'4) <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Y4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT W SOLID WASTE FACILrrY i'') f <br /> [T� OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILfTY ❑ SOLID WASTE VEHICLE <br /> r4i UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL M DAIRY <br /> 1; HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ® PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBOOYPEIRCING ❑ P60LJ9SVA Q LAND USE APPLICATION S(TES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE 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 mail tot e <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 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 not be immediately available for review. A new <br /> application may be submitted w1jen the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorpanlzed'by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications recelved after 3;00 pm will be processed the next business day. <br /> CONFIRM APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> R1=WEWED YES NO REVIEW DATE <br /> - I, <br />