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03/11/2003 13:52 FAX 209 9480621 [4001'001 <br /> DATE RECEIVED E110 LOG NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SEKvICES <br /> IV. ENVIRONMENTAL HEALTH DIVISION <br /> IV. ENVIRONMENTAL <br /> ���I304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> MAR 1 1 2003 (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTBUSINESSIA/GENCY <br /> ADDRESSL1-/y/�/,T� 1�,�n!q�1A/��/ �.� <br /> PHONE d � 2- S/O D FACSIMILE 7 v77"' 59 ' — -- <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS • I <br /> SIGNATURE OF APPLICANT DATE Y3 <br /> FILE ADDRESS THIS SIDE EHD STAFFUSE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> U L/ — <br /> ll <br /> II <br /> 11 <br /> l\ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1" UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT Al SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Z SOLID WASTE'✓IEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> X HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> /❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILET, <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA - , ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER 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 checkinfl <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 46L-d138 or mall to h!: <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 filas <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 revlew. 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 EHE):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 /> 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 /> REVIEWED YES NO REVIEW DATE _ <br /> EH 09 14 0&07100 <br />