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ILI <br />01 <br />Mai• 5. 2002 5 07PM Cn"AOR EARTH TECHNOLOGIES No•8600 P .. 2/4 t <br />/GATE R=IYED W LOG NUMSER `J <br />I SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES OWO <br />ENVIRONMENTAL HEALTH DIVISIONW/ ?*Z <br />' �04 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95242 <br />02 _,q Pi. . (209) 468-3420 <br />&IC ,RECORDS RELEASE APPLICATION <br />APPUCANT° BUSINESSIAGgNCY <br />ADDRESS t� <br />RHONE — <br />i• R / <br />T)~N1ATIVAPPUtNrMEN71AT6 ,,,r <br />Pleas ®va 7 o ht�in � days date app!'tcation su4ttal#tal} <br />CHECK BOX M EXPEDITE RFQyES� $87.00 PZE <br />SIGNATURE OF APPLICANT <br />FILE <br />ESS CLAYS <br />DATE <br />PROGRAM ELEb1ENTS SEARCH <br />0 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />[� NOERGROUND TANK P" CLEANUP SITE (LOP) <br />0 HOUSING ABATEMENT <br />P601-11) WASt>w FACILITY <br />Q THER CLEANUP SITE (NON -LOP) <br />10 FOOD FACILITY <br />13 SOLID WASTE VEHICLE <br />1 KDAIRY <br />nNDERGROUND TANK (MONQTORINGIREMOVAL)!~1 <br />DOG KENNEL <br />=CKEN RANCH <br />0 PKG TREATMENT PLANT <br />� OA7-ARDOUS WASTE GENERATOR <br />I TlFRED pEMIT ED FACILITY <br />0 MOTE).. HOTIE"L. <br />0 PUMPIrR 7RUCKIYARDICHEM T01LETS <br />0 TATTOO/BODY PEIRGiNG <br />U3 i41EDICAL WASTE FACILITY <br />d PaOLJSPA '• - <br />0 PUBLIC WATER SYSTEM <br />17 LAND USE APPLICATION SITES <br />0 OTHER (PLEASE SPECIFY ASOVE) <br />1List up to ken addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate boxes). At least one file type MUST be selected. Fax t^ (�09) 464jjj or mail to the <br />address indicated .aboy—i. <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 (44) days after recjipt 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 EHO staff rnay, 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 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 />