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r nu i�b.. C, ,llU UIiL J.0 • 1716-W(0002 P.01 Won) <br /> atlLCrvEp eno LOG un <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION D <br /> . O 304 EAST WESER AVENUE,THIRD FLOOR <br /> ��� <br /> STOCKTON CA 9$202 <br /> (las)4621-3420 SEP 19 2000 <br /> n C�' PUBLIC RECORDS RELEASE APPLICATION <br /> DDRESS I L17� . .JPPLICANr �W,� a WMEW HEAL <br /> TH <br /> 'SERVICES <br /> PHONE � �5U FACSIMILE �(�p J <br /> I <br /> TENTATIVE}APPOINTMENT DATE TIME <br /> (Please give 7 to 10 busineaa days from data of application suomitlal) <br /> CHECK BOX TO EXPEDITE REQUEST•SBr.00 FEE—RE T ACCESSED IN 3 BUSINESS DAYS R <br /> SIGNATURE OF APPLICANT --r- DATE oil <br /> j FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> 1 PROGRAM ELEMENTS SEARCH <br /> 5 <br /> I <br /> i <br /> ENVIRONMENTA HEALTH DIVISION FILES <br /> WUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOOINUABATEMENT ❑ SOLID WASTE FAMUTY <br /> W OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE' <br /> D5�J NDERGROUND TANK CMoNrrORING/REMOVAL) ❑ DOG KFNNEL ID DAIRY <br /> *HAZARDOUS WASTE GFNERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILf1Y ❑ M07ZUKOTEL ❑ PUMPER TRU041YARD)CHEMTDILETS <br /> ❑ TATTOOfDODY PEIRCIHG POOLiSPA d LAND USE APPUCA710N SaFS <br /> Q MEDICAL WASTE FACILITY ❑ PUSUCWATERSYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 7. List up to ten addresses in the space above. Select the type(s)of fllas from the list above by checking <br /> the appropriate box(es)- At least one fila typo MUST be selected. Fax to(208)464.0138 or mail 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 tiles <br /> j will be held for a maximum of five business days for review. Appointments should be eohcdulcd <br /> li accordingly. <br /> 9. A file that is actively being worked on by END staff may not be immediately avallAbla for review. A new <br /> application may be Submitted when the file Is available. <br /> A. Any file not returned in the same condition as relBased will be reorganized by EHD staff at the expense <br /> I of the applicant Future file reviews by the same applicant may require a$37.00 deposit prior to review. <br /> 5_ "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s. Applications received after 3:00 pm will be processed the next business day. <br /> IL <br /> CONFIRMED APPOINTMENT DATE TIME <br /> ATE CONFIRMED PHONE FAX. INITIALS <br /> I <br /> EVIEWED YES NO REVIEW DATE <br /> N as fa aue7po <br /> 1 TDTAL P.01 <br />