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09/17/2003 09:37 FAX 209 9480621 U004/004 <br /> EHO LOG NumeER <br /> VVVVj�Ir j(,�` SAN JO QUIN COUNTYPUPLIC HEALTH SERVICES <br /> , I�I ?, ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> S E P 1 7 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> fVV1F;Ut�(�lE(�JT HEAL-FH PUBLIC RECORDS RELEASE APPLICATION <br /> P. l.Mj T , Pp. In <br /> APPLICANT_1 �1 r _�i BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE Z(xI Ci L00 Q3 j 5 FACSIMILE ZQ'I 0 6 atI ; <br /> TENTATIVE"AFPOtNTMENT DATE �l fL TIME OlZ <br /> (Please®lve T to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 QUEST P 70CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EMD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> L4015-- 8 Ufiju L -• Siv -v <br /> A V <br /> P.•l L, �r t <br /> {r <br /> OCTr ,r <br /> L to 2�I A• ► Ptv�• ti { . <br /> 3 V j y • � <br /> 3 1 " v <br /> ENVIRONMENTAL HEALTH DIVISION FILES {{ <br /> U UNDERGROUND TANK(uST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT RC1 SOLID WASTE FACILITY <br /> 1�1 OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> fA UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 99 DAIRY <br /> IP HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTI;UI•iOTEL ❑ PUMPER TRUCKlYARD/CHEM TOILETS. <br /> 13 TATTOOISOOY PEIRCING ®•P,60 spA -••- &T (AND USE APPLICATION Sr ES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBUC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up t®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. Eax to(209)-464-0138 or mail tot e <br /> address indicated above.. <br /> 2. EHD will notify the applicant if any EMD 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 now <br /> application may be submitted when the file is available. <br /> d. Any file not returned In the same condition as released will be reorganized'by END 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 states 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 CO&IRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ <br />