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09/17/2003 09:37 FAX 209 9480621 0003/004 <br /> ID)I V*/In II \� EHa M <br /> LOG HU9ER <br /> Ind.__.��•=" `' l SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 2003 ENVIRONMENTAL HEALTH DIVISION <br /> SEP 1 7 304 EAST WEBER AVENUE,THIRD FLOOR <br /> E.NVIRUNMENi ' <br /> HEAL)H STOCKi'ON CA 952021 q5 <br /> (los) 468-3420�FRr.�iT/SERviCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ���1 � S1�lfCi, BUSINESS/AGENCY <br /> ADDRESS <br /> PHONE 70:? FACSIMILE 20'--7 <br /> TENTATIVE'APPOINTMENT DATE . l��1 D TIME <br /> (Please elve 7 to 10 b I�day$from date of appacation submittal) �. <br /> CHECK BOX TO EXPEDITE REQUEST-S87.00 FEE— QUEST PROCESSE 3 BUSINESS DAYS 1 1 <br /> SIGNATURE OF APPLICANT - DATE 9 <br /> 1� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTSaSEARCH.r. <br /> DO r4 <br /> Vi-)C rt w 'V) <br /> S i o cx—u,s <br /> O fl l 1 U <br /> L-4 S:4 6 K1. L.,►,L o) 1wa <br /> V4 <br /> J <br /> 1--3 �� 0 + COV-4-LN00 P11_&,A,_AL 1 1, --Ij <br /> F Q'I.SE� Iva <br /> . , �! <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0; SOLID WASTE FACILrTY i�'I <br /> OTHER CLEANUP SITE(NON-.OP) ID FOOD FACIU Y ❑ SOLID WASTE VEHICLE <br /> tg UNDERGROUND TANK(MONrrOR1NG/REMOVAL) ❑ DOG KENNEL JQ DAIRY <br /> M HL ROOUS WASTE GENERATOR ❑ CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> ❑ TIERED PERINn7ED FACILITY ❑ MOTELlHOTEL ❑ PUMPER TRUCK[YARDICHEMTOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOL/SPA - ' ' = LAND USE APPLICATION SITES <br /> Q 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 to the <br /> address indicated above- <br /> 2. <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 rearganized 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 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 IN1717IALS <br /> REVIEWED YES NO REVIEW DATE <br />