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0/1ll/LUV4 .11:56 IA3 ZUl1 Y48UBZ1 > LejVaL <br /> DA R40 I\�! I� Ili � 040LOGNUMBER`SAN JOAQUIN COUNTYPUBLIC HEALTH 'SERVICES <br /> { JUN 3 0 2004 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ;i!!R ;v,rlEiv? E�ILfiH STOCKTON CA 135202 <br /> (209)448-3420 <br /> FcR[iiTISERVICE�UBL[C RECORDS RELEASE APPLICATION <br /> i <br /> API PLICANT, — "G\I BUSINESSIAGENCY <br /> ADDRESS S.! 1 + <br /> PHONE z{_� �. Lk 3 FACSIMILE Ct L{ s~d Ia -Z1 <br /> TENTATIVE*APPOINTMENT DATE � �b a T11Ma <br /> j (Please give 7 to 10 business daysfrom date of applitallon submittal) <br /> I <br /> CHECK BOX TO EXPEDITE REQUEST-457.A0 F —REQUEST OCESSED IN 3 mUS[NESS DAYS <br /> S GN ATURE OF APPLICANT DATE 6 62zo <br /> FILE ADDRESS THIS SIDE EHD STAFF E ONLY <br /> OMI=N EARCH l <br /> i <br /> l�0 ay 4 0 0 WF--2: <br /> P, %70 <br /> j IM <br /> ENVIRONMENTAL HEALTH DIVISION FILES V <br /> 57 UNDERGROUND TANK(UST)CLEAt�IUP SITE(LOP) ❑ HOUSING ABATEMENT M SOL.1 WASTE FAC{LIiY � <br /> in OTHER CLEANUP SUE(NON4,OP) o FOOD FACILITY SOLID WASTE VEHICLEqj , _�L <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) CI DOG KENNEL � DAIRY ��f <br /> Q CHIGKIwN RANCH l�PKG TREATMENT <br /> 1� HAZARDOUS WASTE GENERATOR lj IAOTELIHOTEL .0 0UMPEt TRUPY YARDICFi OiLETS <br /> C4 TIERED IBOuy TED FACILITY Q pOOUSPX -• ' P'LAND UseAPPL[CAMON SITES <br /> O MEDICAL <br /> WAS FEACILrRCING Cl OTHER(PLEASESPECIFYABOVE) <br /> Q MEDICAL WA5'fl=FAC1LrfY � � PUBLIC 1AfATER SYSTEM <br /> T Ust up to ten addresses In the space above. Select the types)of_files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 4-64&138 0�mail to the <br /> I address Indicated above.. <br /> 21 EHD will notify-the applicant if any.EHD files exist. An appointment for review will be <br /> confirmed. <br /> I approximately five business'days but no later than ten(10)days after roCeipt of application" The files <br /> I 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 tieing worked on by EHD staff-may not be immediately avaliable far review. A rtev <br /> application may be submitted when the file Is available, <br /> 4I. Any file not returned In the same condition as released <br /> t may rer gars a$87.00 deposEHO it pilar to rat the ev sc <br /> of the applicant. Future file reviews by the same applicantY <br /> 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be.processed the next business day. <br /> I . <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL,$ <br /> �EVlEW3=D YES NO REVIEW DATE <br /> I <br />