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-JUL- 11 -03 FRI 0159 PM SAIC - SACRAMENTO FAX NO, 916 974 8830 P, 02 <br /> ITi RECEIVW I i' i_ ' � ENO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> JUL 1 i 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 85202 / <br /> (209) 4683420 <br /> Pri i,, IT " r % Cr_ s PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT dzz) Aa BUSINESS/AGENCY <br /> . ADDRESS 6L4F!" ,y Wr o4,C �9S-74z / <br /> PH0NEC ,'1G) 'g77 - 3rNl FACSIMILE C /(o� <br /> TENTATIVE" APPOINTMENT DATE TIME <br /> f7I <br /> (Please give 7 to 10 business days from date of application suhmittal) <br /> M/ <br /> CHECK BOX TO EXPEDITE REQUEST - 589.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DDRE THIS SIDE EHD STAFF USE ONLY <br /> e<11 �20PROGRAM ELEMENTS SEARCH <br /> i✓ LL <br /> 17+ <br /> 0 <br /> a 3 <br /> / F5iY! <br /> �3 ESQ ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ )XI)ERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Pr OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> CO TATTOO/BODY PEIRCING ❑ POOLISPA ❑ 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) 46"138 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 /> 31 A file that is actively being worked on by EHD staff may not be immediately availabia for review, A new <br /> application may be submitted when the file is available. ' <br /> 4. Any file not retumed 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 deposit prior to review, <br /> 5. 'TENTATIVE appointment dates must be confirmed.with EHD staff, <br /> 61 Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT `DATE TIME <br /> PATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES N0. REVIEW DATE <br /> >:roawzwua - — <br /> apWzvo� <br />