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SAN JOAQUIN COUNTY <br /> EN' 'ONMENTAL HEALTH DEPARTIV, IT <br /> r4'EAST WEBER AVENUE,THIRD FLOOR <br /> JUN 2 6 2003 STOCKTON CA 95202 <br /> '4 (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> O'Le"V <br /> APPLICANT 4f< <br /> T W4TV -BUSINESS/AGENCY <br /> ADDRESS <br /> P H 0 N 1- (-3 FACSIMILE—?—()!? <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$ 00 E- EQUIEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 4-2_C -0'3 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> C- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0. HOUSING ABATEMENT 11 SOLID WASTE FACILITY <br /> BOTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ffl__�LNDERGROUND TANK(MONITOR]NGIREM OVAL) 13 DOG KENNEL 13 DAIRY <br /> &-HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH Cl PKG TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCKfYARDICHEM TOILETS <br /> 0 TATTOOIBODY PEIRCING 0 POOL/SPA 0 LAND US PPLICATLON SITES <br /> ah <br /> 0 MEDICAL WASTE FACILITY �'OTHER(PLEASE SPECIFY), A-6i <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 /> X/ <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 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 INITIALS <br /> REVIEWED YES' NO REVIEW DATE <br /> EK0 4a-02.006 <br /> 312W2003 <br />