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Oct? 14 03 05:42p p 1 <br /> t.)1 <br /> rH�� vt <br /> SAN JOAQUIN COUN _ —" tHU LUG NUMUEH <br /> OCT .1 �L003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ��� <br /> (209)468-3420-I' t PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT la�(A I l l d�C�JZ 1 BUSINESS/AGENCY <br /> ADDRESS4. <br /> PHONE FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Ptoaso glue 7 to 10 buunees days from date or Oppllca(lon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-589,00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS u <br /> SIGNATURE OF APPLICANT DATE i v <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILrTY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) b DOG KENNEL ❑ DAIRY <br /> t1AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING CI POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. list up to ten addresses in the space above. Select the type($) of fifes 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 tater 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 worsted on by EHD 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. Futuro 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 /> REVIEWED YES NO REVIEW'DATE <br /> Emo 46.02•0m <br />