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• ooz/ooz <br /> —11-2�30/2003 lz:ao FAX 209 aaar� <br /> Loc N�� <br /> onre FEC8VED <br /> SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> UEC ? [1G zoo` STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT F' ��A{rSr S SUSINESSIAGENCY k L- <br /> ADDRESS 1� Kin a C� <br /> PHONE 5l-[�- tl q5' -FACSIMILE q 6 2 ) <br /> TENTATIVE'APPOINTMENT DATE I (q 01 TIME UJ <br /> (Please give 7 to 10 buslness days from date of eppamaon !UbmittaqQ CHECK BOX TO EXPEDITE REQUEST.$47.00 FEE- EST PROCESSEDW 0BUSINEDAYS , t J <br /> DATE 1Z 3d 03 <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIDE EHL STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> f F IZ I a D j T01- C A 1✓ <br /> t1 _ <br /> `, " l r ' <br /> D v <br /> t• L� ', <br /> I• rt <br /> S I ( u kf <br /> ENVIRONMENTAL HEALTH DMSION FILES <br /> HOUSING SOLID WASTE FACILITY <br /> IF UNDERGROUND TANK(UST)CLEANUP SITE(LOP) LI F000 FACILITY <br /> O SOLID WASTE VEHICLE <br /> tA OTHER CLEANUP srm(NON3.OP) DAIRY <br /> tg UNDERGROUND TA14K(MONITOR1HG/REMOVAL) El DOG KENNEL ® PKG TREATMENT PLANT <br /> Q HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH b PUMPERTRUCKrYARD/CHEM TOILETS <br /> Li TIERED PERMHTED FACILITY CI MOTEIIHOTFI gd LAND USE APPLICATION SITES <br /> IS <br /> 0 TATTOOOOY PE<RCING ❑ POOLISPP. ..- CI OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY EX PUBLIC WATER SYSTEM <br /> 1. List up to ten addresses In the space above. Select the type(s) of files to from <br /> om the lista 3ove bmacl a deg <br /> the appropriate box(es). At least one file type MUST be selected. <br /> address indicated above. . <br /> 2. EHD will notify the applicant if any EHD files exist An appointment foreview <br /> e et of-application.ill he imed files <br /> approximately five business days but no later than ten(10) day receipt <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 he immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by expense <br /> EHD staff at the exp <br /> of the applicant Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. '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 APPOINTMENT DATE TIME. <br /> DATE•CONFIRMED PHONE FAX INITIALS <br /> ilFVtGWFn YF_^+ Pori pFvIFW nnTF_ <br />