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09/16/2005 13:30 209472E PAGE 02/02 <br /> �G 67 28 �, ! D 46x0138 ENUIROi WENTAL HEALi PAGE 2 <br /> ;cc MAM <br /> SAN JOAQUIN COUNTYPUELIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 5 F P S ���5 " 304 EAST WEBER AVENUE,THiRD FLOOh f <br /> ENV2M" U11' IiEALTH STOCKTON CA 95202 <br /> PEp''";T! Ef?VICES (209)468.3420 <br /> PUBLIC RECORDS RELEASIN APPLICATION <br /> APPLICANT VA PUSfN=1A(;tICY lin es �nylrcSY�wze <br /> ADDRESS,(0 GAY CCC f C? �/` U t mak' <br /> PHONE -22 <br /> �� Z-- 2� —FACSIMILE <br /> TENTATIVE'APPONTINMW DATF aLfTIME <br /> (Ptea9e <br /> 0"7 to 10 busittess dS"from date of applii;000 submittal}, <br /> CtiECK BOX TO EXI'MITE REQUEST- 89.00 FEE-ROCkssED iN 3 BU N Y <br /> SIGNATURE OF APPLICANT - ED) I <br /> FILE ADDRESS THiS SIDE EMP STAFF USE ONLY <br /> pROGRAM ELEMENTS SEARCH <br /> V n rpp rp n. n <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> LEAN <br /> to HOUSING ABATEMENT U SOLID WASTE FACILITY <br /> UNgl=R TANK(UST) PAIVUP SITE(LOP} D FOOD FACWTY O SQLM WASTE VENICE!` <br /> R CLEANUU P SITE(NgN.LOIftoft <br /> p} II ooG KENNEL ❑ DAIRY <br /> - <br /> UNDERGROUND TANK(MOII1TORfit61REiVIL71/At-1 ❑ CHVII RANCH ❑ PKG TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GV(ERATOR ❑ MOTELA-IOTEL ❑ pUMPER TRUCKNAjZ=HFM YOILETS <br /> ❑ YIERED PERMITTED FACIll7Y ❑ PCOtISPA O LAND USE APPLICATION SiTES <br /> in TATTO aODY PEIRCtNG ❑ PUSLIC WAT911 SYSTEM II OTNE>7(FL>! IE SPECIFY ABOW <br /> to MEDICAL WAsTiE FACILITY 00 <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by Ch"king <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0136 or mail to the <br /> adgressjnSfi�.JtedabbVe. <br /> ed 09 <br /> 2. EHD will notify the applicant if any END files exist An appointment for reV[G b1�t pnrm files <br /> approximately five bUk;iness days;but no Fater than ten(10)days afterof Al receipt pp <br /> will be heed for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively beir9 worked on by ENO staff may not be immediately available for review. A new <br /> appliest(an may be submitted when the file iS availmble. <br /> 4. Any rile nct returned in the same condition as releas ll be square a $89-00 nized by DeP a t t the <br /> t Xre"mow' <br /> pense <br /> of the applicant Futuna file reviews by the same applicant <br /> y, "TENTATIVE Appointment dat&s must be confirmed with EMD staff. <br /> G. Applications received after 3:00 pin will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIM <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO R1cV1EW DATE x <br /> 9a, <br /> n <br />