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05/09/2003 14:48 9255517464 ENVIROFORENSICS PAGE 01/01 <br /> RATE RECENEo <br /> j( RHO LOC NUMBER <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL, HEALTH DEPARTMENT �. Y <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> M,AY 019 L1103 STOCKTON CA 95202 <br /> (209)468-3420 , <br /> l OUBLiC RECORDS RELEASE APPLiCATION <br /> APPLICANT _BUSINESS�AGENCY - <br /> ADDRESS 11�'1SvV\ti-, <br /> PHONE 9RIS S5 1 - °.2 FACSIMILE 6,�5�5��'� !_� cy�) <br /> TENTATIVE'APPOINTMENT DATE-�L�si .C]'twY I.S" TIME _mt5 <br /> (Please give 7 to 10 buslnbss&'Ye from date of application submittal) <br /> tMl) <br /> ff" <br /> CHECK BOX TO EXPEDITE REgVE5T-*119.00 E®UE3'r PROCESSED IN 3 BUSINESS DAYS <br /> Lf <br /> SIGNATURE OF APPLICANT - <br /> �.aa FILE ADDRESS THISSIDt?EI CIr AFF USE ONLY <br /> PROGRAIN CLENii?NTS SEARCH <br /> r <br /> `t1 - — <br /> jq.�.a <br /> IM02 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> MIA NDERGROUND TANK(UST)CLEANUP 317E(LOP) ElHOUSING ABATEMENT El SOL ID'NAS'iE FAC:IUTY <br /> VHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASl E VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL Cl DAiRY <br /> t7 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKC;TREATMENT PLANT <br /> Cl TIERED PERMITTED FACILITY Ci MOTEUHOTEL Cl PURIPE R TRI.JCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA CI LAP D USE A^PUcA'noN SITES <br /> CI MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)__.—.------. <br /> 1. <br /> PECIFY) --- <br /> 1. List up to ten addresses in the space above. Select the type(s)of fifes from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Pax to(Z.)454-0135 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for raview ivill be Confirmed <br /> approximately five business days but no later than ten(10)days after r®I:eipt of application. Tlie files <br /> will be held for a maximum of five business days for review. Appolntme ats should be schedulad <br /> accordingly. <br /> 3. A file that is actively being worked on by EHO staff may not be Immodiat:ly 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 al:released will be reorganial:d by E;iD:,diff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $119.00 del:v9sit prior to reviaW. <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 da!r. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX 1141TIALS <br /> REVIEWED YES NO REVIEW DATE _ — -- <br /> �H <br />