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09/17/2003 09:37 FAX 209 9480821 lj�003/004 <br /> ILI,, • • Elle Loc XUNeep <br /> SAN JOAQUIN COUNTYPUSLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SEP 1 7 2003 304 FAST WEBER AVENUE,THIRD FLOOR ENVIRO(J(vIEN l HEALI STOCKTON CA 95202 jqq5 <br /> (209) 468.3420 <br /> PFRkAIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ��J L +� S'1f1C L)E -� BUSINESS/AGENCY it I.F.)IST rYA .I>'F� <br /> ADDRESS— <br /> PHONE <br /> C��fL`�C � <br /> PHONE -M��'( L� —'�t'�S FACSIMILE LLGJ-47 L/7)�O• Z- J <br /> TENTATIVE*APPOINTMENT DATE q I2,;:0Q 3 71ME 12,'C70 <br /> (Please glue T to 10 6 l�days from date of application SUbmktap r <br /> L� CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE- QUEST PROCESSE 3 BUSWESS DAYS , f \ <br /> SIGNATURE OF APPLICANT — DATE O (` " y,1 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY 0 <br /> PROGRAM ELEMENTS SEARCH <br /> % <br /> 3 (zo <br /> A111 <br /> 546 u, wit D.L wa � � <br /> 00 0 /TIL <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Pt UNDERGROUND TANK(USTI CLEANUP SITE(LOP) n HOUSING ABATEMENT (9 SOLD WASTE FACILITY %%�?"'' �` ✓' ' <br /> E OTHER CLEANUP SITE(NON-LOp) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> L)t UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL X DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUGK/YARDICHEM TOILETS <br /> C3 TATrooie0DYPEIRCING 0-P000SPA - • M'LANo USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVE) <br /> 1. List up to ten addresses in the space above, Select the type($) 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 mall tO the <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 $87.00 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 buslneas day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />