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02/11/03 TUE 14:29 FAX 925 253 4985 TREADWELL & ROLLO ut 001 <br /> SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES cwo yor.HUMoew <br /> �F _B 1 QQ� ENVIRONMENTAL HEALTH DIVISION115 / <br /> 304 EAST WEBER AVENUE,THIRD FLOOR J <br /> L H STOCKTON CA 95202 ` <br /> ( (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY <br /> y, ADDRESS _�- <br /> PHONE - - CO FACsiMILES' <br /> - <br /> r 2,1985 <br /> TENTATIVE'APPOINTE <br /> MNT nATE_-_Fe-b Lo /Qi` TIME <br /> (Please elve 7 to 10 bYSInots days from data or application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST 9.00 FEE— VEST PROCESSED IN 3 BUSINESS DAYS u/ • �! <br /> SIGNATURE OF APPLICANT p f[I// DAl-I; (l <br /> FILL•ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 41 w tk� GrsIR <br /> Tmr�rlt rip 460 `t ac r <br /> 5� was+ l a <br /> 4-74v1'.no Rn�A -rt 5 AI <br /> 7 1715 -r oaf to <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> lid UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT El SOLID WAs7rE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDEROROUND TANK(MONITORINGIREMOVAL). ❑ DOG KENNEL O DAIRY <br /> HA7,ARDOUS WASTE GENERATOR O CHICKEN RANCH . O PKG TREATMENT PLANT <br /> R <br /> TIERED PERMITTED FAOILY 13MOTEUHOTOILETS <br /> EL O PUMPER TRUCKIVARDICHEM T <br /> ❑ TATT00/0ODY PEIRCING O POOUSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM O O rHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses in the Space above. Select the type(s)or riles from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464.0136 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD riles exist. An appointment for review will be confirmed <br /> approximately rive 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 forreview. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that);active) bieln worked on b EHD staff may not be immediate) available r <br /> Y 0 Y Y Y or review. q new <br /> application may be submitted when the filo 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. Future rile reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5. vTENTATIVE 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 /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED <br /> YES NO REVIEW DATE ,.r <br /> T. 71nHJ GPTMbgb Tb:RT 7.R417/7.T/TT <br />