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�r <br />Mar• 5. 2002 5:07PMOR <br />EARTH TECHNOLOGIES No•8600 P - -4/4 <br />inn L06 NUMBER <br />SAN JOQUIN COUNTYP613LIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION 001 <br />W AV <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKfON CA 95202 <br />02 Hifi R -5 FM 4: 07 • (209) 4M-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT .-al BUSINESS/AGENCY <br />ADDRESS /� �, e <br />PHONE _ � �'� SJ-.. 2 � T FACSIMILE <br />TENTATIVE' APPOINTMENT DA'Z'E � � l °'l&r.4-1 O�- TIME <br />(P(oase nive 7 to 10 busme93 :43, <br />lies n submittal) <br />MAS <br />r CHECK BOX TO EXPOITE REQUEST - $8 .00 FEE - REQ T S 1 RAYS <br />•�•THIS SIDE <br />PROGRAMy <br />WWOU <br />. i <br />I • 1 liA. _ ,/ Ab �. X71' ' _ � -�--i , <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />M'UNDERGROUND TANK (UST) CLEANUP.9rrE (Lop) <br />❑ HOUSINGABATEWNT <br />a SOLID WASTE FACiLtrY <br />0 OTImER CLEANUP SITE (NON -LOP) <br />0 FOOD FACILITYIUD <br />WASTE VEHICLE <br />'UNDERGROUND TANK (MONITORING/REMOVAL) <br />0 DOG KENNEL;'AAIl2Y <br />02'NA7-ARDOUS WASTE GENERATOR <br />. Er-CHiCKEN RANCH <br />0 PKG TREATMENT PLANT <br />t!1- 1ERED PERM17 MD FACILITY <br />D MOTELIHOTEL <br />0 PUMPER TRUCK/YARD/CHEM TOILETS <br />0 TATTOOIBODY PEIRGING <br />0 POOt./SPA - ' <br />0 LAND USE APPL.IcATION SrMS <br />MEDICAL WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM <br />© OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0130 or mail to the <br />a dress indicated above. <br />2. EHD will notify the applicant if any EHD flies 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 file not returned in the same condition as released will be reorganized by EHD staff at the expense <br />of the applicant. Future fife reviews'by the same applicant may require a $87.00 deposit prior to review. <br />S. *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 INITIAL <br />