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09/17/2003 09:36 FAT 209 948067' x]002/004 <br /> DATE I'. IJMO LOG HUMMER <br /> N JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 17 2003 STOCKTON CA 95202 <br /> (209)4683420 <br /> ���li;�i1PJ1ENl <br /> j-j1E[\0HpIJE3LIC RECORDS RELEASE APPLICATION <br /> -- <br /> AFPUCANT K-I' BUSINES5/AGENCY � �LrL�GI dL-CL <br /> ADDRESS <br /> PHONE 20`) FACSIMILE 2 t7`� b'q <br /> TENTATIVE'APPOINTMENT DATE -( /1-' /0-3 TIME Zcia <br /> (Please give T to 10 business days from date of application subrnttal) <br /> 01 <br /> CHECK BOX TO EXPEDITER U>"$T.$ 7.00 F -REQUEST PROCESSED IN 3 BUSINESS DAYS k <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY ( ` <br /> PROGRAM ELEMENTS SEARCH <br /> " Z3 ;- 1 IS A MCI � <br /> 2 <br /> M u 17. �,\,4\j I� <br /> �t C i �rV ii Ir <br /> 1211 T1 ( r, <br /> t o S fo <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Cr <br /> 1% UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT 1� SCUD WASTE FACILCTY <br /> R OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Q SCUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL U DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT <br /> d TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> d TATTOOlBODY PEIRCING ❑ POOIISPA R LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBUC 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 boxes). 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 tiles <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. Fu ure 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 business day. <br /> CONFIRMED APPOINTMENT DATE TIME. <br /> BATE CONFIRMED PHONE FAX INITIALS <br /> RE=REYYED YES NO REVIEW DATE <br />