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FRAM NOA Erw i rormenta l PHS NO. : 2@9 369 4228 Dec. 23 2002 12:24PM P2 <br /> En VC NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH ERVICES ' <br /> ( ENVIRONMENTAL HEALTH DIVISION <br /> -),,304 EAST WEBER AVENUE,THIRD FLOOR <br /> DECSTOCKTON CA 95202 <br /> 2 ZOd2 (209)468.3420 ; <br /> 091' <br /> �P-h/jk1r1'1.6?.ier-.A, PPPLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1' bUS11YES5rAGZ;NCYU.r'o rc l„ <br /> ADoREss art Lome L4: /r .hyo <br /> PHONE L-0�� �o�-370 - - -- FAcsimit.E(2 ) <br /> A ds <br /> �I'�EIVTATIVL='APPOINTMENT DATE � 2003 TtME r i <br /> (Please give 7 to 10 business days from data.of application submittal). <br /> CHECK BOX TO EXPEDITE REQUEST-$69.00FEE--RE T P OCESS913 IN 3 BUSINESS DAW r I <br /> 'r ` a2•` II <br /> SIGNATURE OF APPLICANT DATE <br /> P <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �a <br /> - <br /> PA P"..; s I <br /> ENVIRONMENTAL.HEALTH DIVISION FILES [� <br /> IM UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT a SOLJD WASTE FACILITY <br /> jr OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13 SOLID WASTE VEKICLE <br /> JO UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> 9 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH G PKG TREAYMEWr PLANT <br /> C1 TIERED PERMITTED FACT Y O MOTEunonl- ❑ pVMpER TRUCWYARDICHEM TOILETS <br /> ❑ 7ATT0018oDY P£IFiCING <br /> ❑ MOLISPA O LANG?USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY In PUStie WATER SYSTEM tR OTHER(PLEASE SPECIFY ABO <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. Kax to 209 464-0138 or mail to the' <br /> address indicated above <br /> 2_ EHD will notify the applicant If any EHD files exist. Ari appointment for review'will be confirmed <br /> approximately five business days but no later than tan (j0)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be soheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4- Any lite not returned in the same condition as released will be reorganized by IGHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may regtltre a$813.00 doposit prior to review. <br /> 5. 'TENTATIVE appointment dates mast be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME. <br /> OATE CONFIRMED PHONE FAX INITIALS. <br /> REVIEW DATE <br /> I REVIEWED YES � NO , <br />