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Mar • 5. 2002 5:07PM COQ OR EARTH TECHNOLOGIES No•8600 P• 2/4 <br />/6AIC RF.C� ED X110! OC liUOaUI R <br />I SAN JOAQ,UIN COUNTYPU13LIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISIONAt 0=0 W/ ff--m <br />I _X04 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95242 <br />i (208) 468-3420 <br />bgglC RECORDS RELEASE APPLICATION <br />APPLICANT t� _Q BUSiNESS/AOENCY (,/ , <br />ADDRESS t CJ <br />a <br />PHONE <br />TENI'ATIVE� APPOINTMENT DATE '� d � .7tME <br />Please give T o ht�in S days � date app!'ecatlan submi#ta!} <br />13 CHECK BOX TO EXPEDITE REQgE - $87.00 Ftp N SINESS GAYS <br />SIGNATL.11RE OF APPLICANT {{ -T GC-�i'� DATI~ <br />ENVIRONMENTAL HEALTH DIVISION FILES <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 bg (4091 464-0138 or mail to the <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 recjipt of application. The files <br />will be hold 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 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 file reviews by the•same applicant may require a $87.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be•conflnned with EHI3 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 />d <br />"OLID FACILITY <br />[3�NOERGROUND TANK [UST) CLEANUP SITE (LOP) <br />HOUSING ABATEMENT <br />WASE <br />Q• gTHER CLEANUP SITE (NON -LOP) <br />A FOOD FACILITY <br />CD SOLID WASTE VEHICLE <br />Gt�DAIRY <br />DERGROUND TANK (MONITORING/REMOVAL) <br />0 DOG KENNEL <br />A�ARDOt�CHICKEN <br />P <br />RANCH <br />0 PKG TREATMENT PLANT <br />I1~t2ED PEI iTI"Ei? FACILITY <br />II LiOTEL/HOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TO:Lt T3 <br />a TATTOO/BODY PEIRCING <br />❑ POOL SPA '• - <br />Cl LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM! <br />0 o-n4ER (PLEASE SPECIFYANOVE) <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 bg (4091 464-0138 or mail to the <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 recjipt of application. The files <br />will be hold 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 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 file reviews by the•same applicant may require a $87.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be•conflnned with EHI3 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 />