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10-02-2000 013:01FI~ FRTO 19256863099 P.0': <br /> 7,.i titF.CJVEp I �. L4D LJG KVrY?1C'R <br /> s e SAN JOAQUIN COUNTYPUBLiC HEALTH SERVICES �� I <br /> 1 ENVIRONMENTAL HEALTH DIVISION <br /> 'r u 304 EAST WEBER AVENUE,THIRIJ FLOOR <br /> i STOCKTON CA 95202 <br /> (209)468-3420 <br /> k. <br /> 6BLIC RECORDS RELEASE APPLICATION ° <br /> APPLICANT On BUSINESSlAGEICY <br /> 9S <br /> ADDRESS j��9y �i l f ou 3 pCi.� � - 000 <br /> P}fONE q Z5 U `ib `� 0 S 9 �Ro <br /> FACSIAI� <br /> TENTATiV E'APPvllti(FiewT live to 1 G�u <br /> /10 O TIME J��: azQ Ga.r-1'i l r/SERVI(��S rH <br /> i(Please give 7 to•JO bu s ayi 64Den date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-S87.00 FEE-REQUEST PROCiN 3 BUSWESS DAYS <br /> SIGNATURE OF APPLICANT, _____ DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 5? E Vic-fpr C.r-t <br /> � 1JJ <br /> -3 <br /> 9 b I ick <br /> 13oS o o — - <br /> tNVIRONIMENTAL HEALTH DIVISION FILES <br /> iSOLID <br /> FS UNDERQRWNO TANK(UST)C}-2ANUr SITE(LOP) FOODHOUSIFA trFY NG neENT SOLID WASTE-FACILITY <br /> �OTHER CLEAAtUP SITE(MON STE <br /> -L. ❑ DAIRY <br /> -Ag_UHDERGROUND TANK(MONITORINGIREMOVAL) CIDOG KENNEL p pKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH <br /> L] ➢[OTEUHOTEL ❑ PUMPER Tfi11CIUYARDI(]JEM TOILETS <br /> 'igrl 7JE!FED PERMMVD FACiLTY I ❑ P60L ISPA W.LAND USE APPLICATION 8ire3 <br /> ❑ TATTCXXBODY PEIRCING i PUBLIC WATER SYSTEMA ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 114 MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses 1� the space above. Select the type(s)of files from the list above by checking <br /> the appropriate boz(®s). At least one file type MUST be selected. Fax to (209)46"138 or mail to the <br /> address indicated bone. <br /> 2. EHD will notity thejappliont if any EHD files exist_ An appointment for review will be confirmed <br /> approximately hvo;business days but no later than ten (10)days after receipt cf application. The files <br /> will be held for a rriaximurr 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 review. A nevsr <br /> Application may be submitted when the file is available. <br /> d. Any file not retum�d in the same condition as released will be reorganized by EHD staff at the exponsc <br /> of the applicant. l Uture file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. `TENTATIVE appointrnentidates must be confirmed with EHD staff. <br /> 6. Applications receWed after 3:00 pm will be processed the next business day. <br /> I <br /> i <br /> CONFIRMED APPOINTMENT DAtE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />