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Oct 4.4 03_ 05:42P P. 1 <br /> SAN JOAQUIN COUNTY t"U LUL:NUMHER <br /> OCT 152003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> i ;SERF iC ES (209)468-3420 :. <br /> II PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ` -BUSINESS/AGENCY <br /> ADDRESS <br /> PHONE FACSIMILE_ ��� ( — 7 g 3 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please glue 7 l_.110 bucinecs days R-em dateor.ppl(ullon;u;wlltal) <br /> CHECK BOX TO EXPEDITE REQUEST-S39,00 FEE—REQUESTROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L r / <br /> r�� �1--y-�.���I DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ( a -7 <br /> "3 �' r� <br /> ( �� � <br /> ' (� <br /> ENVIRONMENTAL HEALTH DIVISION FILES ---+,1'.I�. � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILJTY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) M DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR D CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MC)EUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOlBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 01-HER(PLEASE SPECIFY) <br /> f. Llst up to ten addresses in the space above. Select the type(e)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 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 END staff may not be immediately available for review- A new <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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 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 /> REVIE=WED YES NO REVIEW'DATE <br /> LMO 44.02.006 <br /> 3402003 J / <br />