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,10130/2090 ?2:20 20946H�40F3 FIFTH FLOOR <br /> RECErvED SAN JOAQUIN COUNTYPUSLIC HEALTH SERVICES <br /> ENVIRONMENTAL. HEALTH DIVISION. OCT 3 0 ZOOO <br /> 344 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 ENVIRONMENT HEALTH <br /> (209)46$-3420 PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> CY r dd fa <br /> APPLICANT d <br /> ADDRESS <br /> FACSIMILE,_ <br /> TENTATIVE*APPOINTLIENT DATE /� IlJ� TIME <br /> (Please give 7 to ID busine s days from date of application sub.nittal} <br /> CHECK BOX TO EXPEDITE REQUEST-38T.DD FEE'—REQ ED IN 3 BUSINESS DAYS <br /> DATE is ". OO <br /> SIGNATURE If APPLICANT <br /> FILE ADDRESS THIS SIDE END STAFF t15E ONLY ` <br /> PROGRAM ELEMENTS SEARCH <br /> Z5� S awnCA u . S -i-oC ".d-D Pt <br /> I � _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLg)WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILFTY ❑ soLl)WASTE VEHICLE <br /> 12 OTHER CLEANUP SITE(NON-LOP) p DAIRY <br /> C3UNDERGROUND TANK(MONITORINGIREMOVAL) E3 r HIKENNEL <br /> N RKEN RANCH E3PKG TREATMENT PLANT <br /> ❑ MMOTEL/ <br /> Q HAZARDOUS WASTE GENERATOR OTE <br /> ❑ TIERED P£RtdrrTED FACILITY HOTEL ❑ <br /> ,_. PUMPER TRUCKlYARD/CHEM TOILETS <br /> ❑ pOOLlSPA - ❑ LAND USE APPLICATION Sr;ES <br /> ❑ TATTOOIBODY PEIRCING ❑ pUBUC WATER SYSTF3A ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY <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 boxtes). At least one file type MUST be selected. Fax to(2091 464-0138 or mail 1a the <br /> address indicated abpopve. y ointment for review will be confirmed <br /> 2. EHD will notify thea licant if an EHD files exist. An app <br /> approximately five business days but no later than ten (40)days after receipt of application. The files <br /> will be held for a maAmum 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 /> dpplication 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 tho expense <br /> of the applicant. Future filo reviews by the same applicant may require a$57.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. Applications received after 3:04 pm will be processed the next business day- <br /> CONFIRMED.APPOINTMENT <br /> ay.CONFIRMED.APPOINTMENT DATE TIME <br /> DATE CONFIRMEDPHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE°. _ <br /> 01 0014 "'0790 <br />