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FAX N0. : 2095690295 Nov. 26 2002 12:36PN P2 <br /> � FROM Geo Phase Erwtron ental ..r.. 11t <br /> Fil� = ( � Jird ..... �� <br /> ( .� ';IIT/ lr_UN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> y r NOV 2 6 2002 304 EAST WEBER AVENUE,THIRD FLOOR <br /> .. <br /> STOCKTON <br /> CA 95202 <br /> ENVIF)'ONMENi HFALTH ( ) <br /> pERUF/SERVICESPUBLIC RECORDS RELEASE APPLICATION <br /> :.. , A PLICANT safe 41^4441i"di _BUSINUSSIAGENCY GPo 1141 �'-►+�'/"O"„a�"�a� <br /> ADDRESSe'W -4576'47 <br /> -4 <br /> PHONE `9 DAg3 FACSIMILE <br /> )-' <br /> TENTATIVE'APPOINTMENT DATE TIME ' �,♦� <br /> (Plc�sc Oivc 7 t0'ID bminc::JaY:Iron oate o(appllcriton sWnatWl) <br /> rV CHECK BOXTO,EXPEDITE REQUEST•$07.00 FEE-REQUEST pROCESSEV 0 BUSINESS DAYS <br /> 14 DATE ` ! <br /> SIGNATURE OF L FFUCANT — <br /> FILE ADDRESS THIS SIDE olio STAFF USE ONLY <br /> PROGRAM ELEMENTSSEARC <br /> 3 e <br /> i <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X UNDERGROUND TANK( CLEANUP slTe(LDP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> 3 0 DOG KENNEL O DAIRY <br /> • UNDERGROUND TANK RINGIACMOVAI) O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASI!E GENERATOR ❑ MOTCUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTK, FACILITY O POOUSPA " - ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY P6IRCING ❑ PUBLIC WATER SYSTEM C1 OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WA$Tg FACILITY <br /> 1, List up t0 ten addresses in the space above. Select the typc(s) of files from the list above by checking <br /> tt c appropriate box(es). At least one file type MUST be selected. Fax to f209) 464-0136 or mail to the <br /> address indicated ove. <br /> 2. EHD will notify the aabpplicant if any EHO 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 an by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the the is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expcnsc <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 EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> i DATE CONFIRMED PHONE FAX INITIALS <br /> i-REVIEWED _ i YES NO REVIEW DATE <br />