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09/17/2003 09:37 FAX 209 9480621 <br /> Q003/004 <br /> y - <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> SEp 1' 7 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> NVIR014MEN 1' HEAUH STOCKTON CA 95202 jqq <br /> (209) 468.3420 <br /> PF.RMITISR1'10ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUS[NESSIAGENCYy�S ���� �� <br /> ADOREssT. <br /> PHONE — FACSIMILE- ZL?�f=5_(y —0 <br /> TENTATIVE"APPowmr::NT DATE q/?,:4- TIME /2=[TJ <br /> (Please glue 7 to I h I�days from date of application submltlal) r <br /> CHECK BOX TO EXPEOI'a REQUEST-$87.110 FEE— QUEST PROGL SS5 3 8USINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE _ Q �� 611 <br /> 1 <br /> "FILEADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM EL:EMEWS SEARCH <br /> 3 <br /> �pf <br /> 00 V ti tt t,. t+ /hL <br /> c7 S Lt t � - <br /> G8 <br /> 4LA 6cLts� •, t, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> lit UNDERGROUND TANK(UST)CLEANUP SITE(LOP) a HOUSING A13ATF-MENT N SOLID WASTE FACILITY <br /> Ip*OTHER CL.EAHUP SITE(NON-LOP) 0 FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> C}t UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL JO DAIRY <br /> I$ HAZARDOUS WASTE GENERATOk C3 CHICKEN RANCH I3 PKG TREATMENT PLANT <br /> Q llERED PERmrrTED FACILITY 0 MOTELJHOTEL PUIrLPER TRUGKlYARDlCHEM TOIL.ErS <br /> P -rATraomoDY PEIRCING Q•PCIOL/SPA IRI*LAND USE:APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY L7.PUBL.IC WATER SYSTEM C1 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 209 464-0138 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 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 reorgantzed-by EHD staff at the expense <br /> of the applicant. Future tale reviews by the same applicant may require a$87.00 deposit prior to review. <br /> b• '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 APFOiNTMENT oA'i'E TIME.•,_,,, <br /> I DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 4 <br />