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v <br />03/28/2003 14:32 <br />elf! - <br />MAR 2.8 2003 <br />i H1 AL Fi <br />APPLICANT <br />ADDRESS <br />20946 <br />AGE STOCKTON <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 85202 <br />(209) 466-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />PHONE Cam) 941 r7- i1 <br />NESS/AGENCY <br />FACSIMILE <br />PAGE E11/01 <br />DID LOG NUMOLR <br />TENTATIVE" APPOINTMENT DATE ALSrT1 TIME <br />(Please give 7 to 10 business days from date of application submittal) <br />>14 <br />CHECK BOX TO EXPEDITE REQUES fl.00 FEE — REQUEST ROCESSED IN 3 BUSINESS DA'(S f <br />SIGNATURE OF APPLICANT .mow' DATE <br />FILE ADDRESS <br />0 <br />tp <br />1 2003 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE: FACIUTY <br />OTHER CLEANUP S1TE (NON -LOP) Cl FOOD FACILITY C 50LID WASTE: VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ 'DAIRY <br />% HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />'❑ TIERED PERMITTED FACILITY C7 MOTEIJHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />❑ TATTOOIBODY PEIRCING O POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ 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(202) Ei�1-0138 or m is I to thq <br />address indicated above. <br />2; EHD will notify the applicant if any EHD files exist An appointment for review <br />eofview will be confirmed <br />approximately five business days but no later than ten (10) days after :�pl�lication. The file s <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 EHO 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 st a ex `' ' <br />' <br />of the applicant. Future file reviews by the same applicant may require. a $78.00 depi i tr <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 />EM 00 14 01/05100 <br />