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03/11/2003 13:52 FAX 209 9480621 U Otll ,ti07 <br /> DATE RECOVED EI/D LOG NUMBER <br /> ( l l rf�SAN JOAuUIN COUNTYPUBLIC HEALTH SEkv,CES <br /> ENVIRO� MENTAL HEATH <br /> rl�` 304EASST,WEBER AVE UELTHIRDF OIOR <br /> STOCKTON CA 95202 <br /> MAR 1 1 2003 (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �I BUSINESSIA�G+ENCY_.0 LT�/�F <br /> ADDRESSr1 l' 15J1/� /�p�li iPf) tJ /� <br /> PHONE �D .� FACSIMILE T-yV? <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of apptication submittal) <br /> • <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS Q • I ' 3I <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF115E ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> v y <br /> � 1 <br /> I � <br /> . t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT r SOLID WASTE I:ik(:ILrY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE'JIEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILET;; <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 13 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the listabove by checking <br /> the appropriate box(es). At least one file type MUST be selected. F x to 20 46,L.&j or mall to <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 EHD staff may not be immediately available for revlew. A now <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 EHL):staff at the, expenso <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 /> En 00 14 "AI7= <br />