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02/02/2004 17:00 FAX 209 4806'' Z002 <br /> AAT&Ox-r-MED 'I I EhD LoG xuueE,Z <br /> \ SAN JOAQUIN_COUNTYPU13UC HEALTH SERVICES <br /> VENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r�(K1'LIS e �'V BUSINESS/AGENCY (�� l ' Q f r� — <br /> Ano ss �q3,-� R /e <br /> PHONE v! '�'yg^ r 3 ys FACSIMILE <br /> TENTATIVE`APPOINTME DATE alio/d TIME IOC SOD u/ <br /> (Please give 7 to 10 business days from date of 3131311MUon submtttif) <br /> CHECK BOX TO EXPED[T£REQUEST-$97.00 FEE,REQUEST PROCESSED IN 3 6USWES5 DAYS <br /> •� <br /> SIGNATURE OF APPLICANT /Z� �� DATE o? a O <br /> FILE ADDRESS THIS SIDE E}10 STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �Ny <br /> X00 �i e as cS oC oat C64 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Ja UNDERGROUND TANK(UST)CLEANUP S11E(LOP) ElHOUSING ABATEMENT SOLID WASTE FACILrTY <br /> OTHER CLEANUP SrrE(NON-I-OP) ❑ FOOD FACILITY O SOUR WASTE VEHICLE <br /> UNDERGROUND TANK(MONtrORING/F{,EMOVAL) ❑ DOG KENNEL DAIRY <br /> HAZARDOUS WASTE;GENERATOR ❑ CHICKEN RANCH �PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY d MOTELIHOTEL O PUMFERTRUCKIYARD/CHEMTOILETS. <br /> ❑ TATTOOtBODY PEIRCING ❑'PDOLISP/K - J0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY PUBLIC WATER SYSTEM 0 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 mall to the <br /> address Indicated above...a. <br /> 2. EHD will notify the appli ant if any EHD files exist. An appo(ntrEnent for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of.application. The fifes <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 beir g worked on by FHD staff may not be immediately available for review. A new <br /> application may be subrr Itted when the file Is available. <br /> 4. Any file not returned Int a same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future Ile reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointmer t dates must be confirmed With EHD staff. <br /> 6. Applications received a er 3:00 pm will be processed the next business day. <br /> rj <br /> CONFIRMED APPOINTMENT DATE TIME.. <br /> DATE CONFIRMED PHONE FAX INITIALS �— <br /> o�nCVlrCr, �! YFC tun _ REVIEW DATE <br />