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02/03/2004 10:.11 FAX 209 9480621 Z 002/002 <br /> t. <br /> DATE ff=vEa . <br /> �Eo %r �i SAN JOAQUiN COUNTYPUBLIC HEALTH SERVICES <br /> CII`� I�'J ENVIRONMENTAL HEALTH DIVISION <br /> FEB 0 3 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIROWEN-1 HEA'I H (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT— J U-� S 1A s 6USINESS/AGENCY <br /> ADDRESS <br /> PHONE_ FACSIMILE qL4 b O6 <br /> r _ <br /> TENTATIVE'APPOINTMENT DATE Zl(3 I0 L TIME <br /> (Pleaso Gve 7 to 10 6uslness days from date of application submtttal) <br /> CHECK BOX Tdi EXPEDITE REQUEST-$87.00 —REQUE T OCESSED IN 3 BUSINESS DAYS ' r <br /> SIGNATURE OF APPLICANT DATE Z 0.3 0 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> /' .. .tea.-�.J.a•_. <br /> i <br /> i <br /> r <br /> ENVIRONMENTAI.HEALTH DIVISION FILES <br /> UNDERGROUND TANK NST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 9k OTHER CLEANUP'SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> ® UNDERGROUND TANK(MONFTORING(REMOVAL) ❑ DOG KENNEL. DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br /> ❑ TIERED PERmn-r A FAcwy ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CREM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑-POOIISPA ID•LAND USE APPLICATION SiTES <br /> ❑ MEDICAL WASTE'FACILITY 14 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List 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(2091464-0138 or mail to the <br /> addressiindicated 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 review. A new <br /> application may be submitted when the file is available. <br /> 4. Any tile�6ot returned In the same condition as released will be reorganlzed by EHD 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 /> f <br /> �I <br /> CONFIRMED APPOINTMENT DATE TIME . <br /> i <br /> DATE CONFIRM ED PHONE FAX INfTIAL S; <br /> REVIEWED �' YES kirl Pr"Plnl nATr- <br />