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06/14/2005 14:18 209369 ' ` NEIL ANDERSON PAGE 02/0' <br />EHD LOG NUME <br />DATE RECEIVED SAN JOAQUIN COUNTY. <br />]ENVXR.®NMENTA L HEALTH DEPARTMENT <br />304 E Weber Ave P Floor StoektOD, CA 95205 - <br />(209) 468-3420 Fix: (209) 464-0138 Web: www.cv.san jvaquin.ca.us/chd <br />PUBLIC RECORDS RELEASE APPLICATION <br />TION <br />ENVIRO'Numc Ni <br />PERMIT/SFRVICES P-0–� BUSINESS/AGENCY: <br />ADDRESS: <br />PHONE:" ` FACSIMILE: ` `T <br />��fl <br />TENTATIVE* APPOINTMENT DATE: ` ,r Z D _ Time: 1ST <br />(Please allow 10 business days from date of application submittal) <br />�.. <br />® CHECK BOX TO EXPEDITE REQUEST - $ 3.00 FEE EQUEST PROCESSED IN 3 BUSINESS DAYS <br />DA7E 40 05— <br />SIGNATURE OF APPLICANT �,_____ — <br />DePartment Use 0111V <br />iqv I I <br />klmlj <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />[] unit 1 <br />❑ Unit 2 <br />Unit`3 <br />Unit 4 <br />❑ Unit 5 4000 <br />C] <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT D SOLID WASTE FACILITY <br />am <br />OTHER CLEANUP SITE (NON -LOP) © FOOD FACILITY O SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIR.EMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL Li PUMPER TRUCK11fARDlCHEM TOILE <br />O TATTOOIBODY PIERCING e. ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />© MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by cheep <br />the appropriate box(es). Af least one file type MUST be selected. ax to 209 464-0138 or mail to t <br />address indicated 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 fi <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 w <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 expe e <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to re- w. <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 />REVIEWED YES NO <br />81W0oo <br />REVIEW DATE <br />