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UNU LUG NUMbtR <br /> SAN JOAQUIN COUNTY <br /> F',EC;E'11V/ ED ENW -NNM NTAL HEALTH DEPARTMI <br /> 3L _AST WEBER AVENUE,THIRD FLOOR <br /> APR 14 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENVIRUNME[1F HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> / <br /> APPLICANT I /r'1 CC( BUSINESSIAGENCY G/�<<-'""�'S <br /> ADDRESS D 3 GP /{ C�-F7'cis t4 ,-.'A <br /> FIN <br /> PHONE Cf r6 -7 FACSIMILE J LO <br /> 4 l�1 7 f7- <br /> NT IVE"APPOINTMENT DATE TIME / <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS I <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH I <br /> ( <br /> C_;,ef 6 . t,).4er 00 <br /> pz tr ✓ et ^�) <br /> 1131. Ir ( r r / <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )I UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> (T!� OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID VWTE VEHICLE <br /> $1 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 'K DAIRY <br /> VW <br /> �a HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> O TATTOOISODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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 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 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 $89.00 depoN <br /> e, .�� R� <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 /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD4"2D H <br /> W2612003 <br />