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07/08/2002 MON 12:50 FAX 916 5654356 001/001 <br /> eI/rjbr Zan< LU'14b ° 13U ENVIRONh1ENT4 HEALTH PAGE 01 <br /> 'SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES a�n�ooNunla¢a <br /> ENVIRONMENTAL HEALTH DIVISION <br /> I/ 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> STOCKTON CA 95202 <br /> (209)463-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ <br /> `} bUSINESSrAGENCY J <br /> AdbRESS 6t <br /> PHONE <br /> PACSIMILE <br /> c'TENTATIVE`APPOINTMCNT DATE <br /> (Please give 7 t i TIMC <br /> css d appil aubmlttal) <br /> CHECK BOX TO EXPEDITE REQUEST- 00 F – Et�EST;FCESSED 1�] !NESS PAYS <br /> -' <br /> SIGNNI1 URF OF APPLICANT <br /> C DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF use ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> a Sz <br /> z <br /> ,W. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> RQ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) o HOUSING ABATEMENT lO SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(HON-LOP) D FOOD EAcnm ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 11 TIERED PERMITTED FACIt rry ❑ MOTELIMOTEL LI PUMPER TRUGKtYAROICHEM TOILETS <br /> ❑ TATTOOMODY PEIRCING d POOL'SPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILrrr ❑ PUBLIC WATER SYSTELI El 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 otle file type MUST be selected. Fax to 209 464-0138 or mall to th,4 <br /> addross indicated above.• , <br /> 2. EHD Will notify the applicant if any EHD files exist, An Appointment for ravieW 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 businoss 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 avalluble, <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 DAI�.. ..— <br /> •n n "�nr � .-- <br /> Post-it'Fax Note 7671 t <br /> oTo WDapt- m®r�' 3 <br />