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09/17/2003 09:36 FAX 209 9980621 U002/004 <br /> GATE RFCENFA % 0410 LOG NUMBER , <br /> i <br /> �� G SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ��� <br /> ;r 1 �—: -s ENVIRONMENTAL HEALTH DIVISION - <br /> 304 EAST WESER AVENUE.,THIRD FLOOR <br /> S E P 17 2003 STOCKTON CA 95202 lqq7 <br /> (209) 468,3420 <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT_ _ -`_1� 1 ,•, •S � SUSINEs.&AGENCY � �Its 1� R- <br /> ADDRESS <br /> PHONE ?O`l /a Lffld, 1-3L1-s:— FACSIMILE ?4) ) 1 <br /> TENTATIVE*APPOINTMENT DATE 3 TIME f <br /> (Please give 7 to 10�5 days from date of application submittal) <br /> CHECK SOX TO EXPEDITE REQUEST-$ 7.40 F -R$QUEST PROCESSED LN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �7 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY [ <br /> PROGRAM ELEME=NTS SEARCH � <br /> -5-7, A L.f 1 ,v A 3 <br /> ,t <br /> M c, a 17. i'r l� <br /> prG 4 L' I -21 <br /> G r i, ,r <br /> rr <br /> • �'UC!`t;�b��s:(--i:ir`/�f-�'- I i r1-�--- !"Lir-r"� `.(�sI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOustNG ABATEMENT G>t SOLID WASTE FACILRY <br /> q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONLTORINGIREMOVAL) ❑ DOG KENNt:L 0a DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH IR PKG TREATMENT PLANT <br /> ❑ TiERED PERMITTED FACILITY ID MOTELIHOTEL E3 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOMODY PEIRCING O-POOLISPAO'L.AND USE APPLICATION SrMS <br /> Q MEDICAL WASTE FACILITY ❑ PUBLIC WAT R 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, EaX to 209 464!Qj 36 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 fife Is available. <br /> 4. Any fele not returned In the same condition as re[oased will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6- Applicatlons received after 3:00 pm will be processed the next business day. <br /> ,CONFIRMED APPOINTMENT DATE TIME.. <br /> DATE CONFIRMED PHONE FAX INrnALS <br /> R nEWED YES NO REVIEW DATE . <br />