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09/17/2003 09:36 FAX 209948062' 1j002/004 <br /> PMO LOG NUMaER <br /> jhSAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 17 2003 STOCKTON CA 95202 lqq7 <br /> (209) 468-3420 <br /> HEALIHPuBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINES5/AGENCY ���L�1ffr—LZL-0— <br /> ADDRESS <br /> - -ADDRESS <br /> PHONE -2O`1 l�7l-{flI 13 Ll S FACSIMILE ?-0g J i H �U 6 ► __ _ <br /> TENTATIVE~APPOINTMENT DATE -L /7,+ �J-3 TIME r Z� <br /> (Please give 7 <br /> to 1�ness days from date of application subm ttal) <br /> CHECK BOX TO EXPEDITE REQUEST•$ 7.00 F —REQUEST PROCESSED IN 3 BUSINESS DAYS ' <br /> SIGNATURE OF APPLICANT DATE /7 <br /> FILE DRESS THIS SIDE EHD STAFF USE ONLY 1 ` <br /> PROGRAM ELEMENTS SEARCH <br /> Z 3 l 1(3 A <br /> 21"2 CA I P • 'z� t In (A^b Y Y e- �j <br /> - Z�'A 0 Z Pr CA LXC- . V I <br /> '-t L <br /> -- r t t 1 �� 1, <br /> 00, <br /> ENVIRONMENTAL HEALTH DIVISION FILES �(41 <br /> Eb UNDERGROUND TANK(UST)CI_FANUP SITE(LOP) ❑ HOUSING ABATEMENT dl SOLID WASTE FACILRY <br /> 4 OTHER CLEANUP SrrE(NON-LOP) Cl FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MO NrrORING/REMOVAL) ❑ DOG KENNEL IN DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH (M PKG TREATMENT PLANT <br /> Ll TIERED PERMITTED FACILITY ❑ MOTEUlHOTEL ❑ PUMPERTRUCKfYARD/CHEMTOILETS <br /> ❑ TATTOO11300Y PEIRCING ❑ POOLlSPA 1Z LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC 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 box(es). At least one file type MUST be selected. Fax to (209) 464-013 , or mall to the <br /> address Indicated above. <br /> 2. I;HD will notify the a plicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five b siness days but no later than ten (10) days after receipt of.application. The tiles <br /> will be held for a m mum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively eing worked on by EHD staff may not be immediately available for review. A new <br /> application may be s bmltted when the file Is available. <br /> 4. Any file not returned n the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Fut re file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. "TENTATIVE appoint ent dates must be confirmed with EHD staff. <br /> 6. Applications receive after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTME DATE TIME, <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REM EVVED YES NO REVIEW DATE <br />