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q I <br /> 07/15/2002 14:35 2094 119 AGE STOCKTON .' PAGE 01/01 <br /> DATA RECEIVED END-lQQ NiJMB� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTWERVICES <br /> ENVIRONMENTAL HEALTH D1VISIO �ECE ,NED � <br /> 304 EAST WEBER AVENUE,THIRD FLOo <br /> STOCKTOR CA 95202 <br /> Zft ' (209)468.3420 JUL 16:2002 <br /> QtUi13LI;C RECORDS RELEASE APPLICATION <br /> A ! d/C, 1. NT HEALTH <br /> APPLICANT CS UAL C. 6USINESS1AGt:NT:Y VICES <br /> ADDRESS 239 sh,2.1 <br /> �f <br /> PHONE �U [J I ACSIMILE. • —N . RUSH <br /> TENTATIVE*APPOINTMENT DATE � L � 'TIME ` Q-ro A <br /> (Please 9 V1 7 to 10 usino"dAW from A&of app' tion Submittal) <br /> 3 I � <br /> CHECK BOX TO EXPEDITE REQUE .011 F��Edll�q PE a IN B SINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ) <br /> FILE ADDRESS <br /> i <br /> I <br /> T <br /> iJ <br /> I= . l I-Th 151rrds <br /> ✓✓ <br /> gT I!.` WPM) fJ r <br /> lU t' C <br /> ENVIRONMENTAL.HEALTH DIVISION FILES � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(Lap) 4 HOUSING ABATEMENT E3 SOLlD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) iF ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) C DOG KENNEL ❑ DAIRY <br /> RANCHHAZARDOUS WASTE GENERATOR C7 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCIUYARn1CHI7M TOILETS <br /> 0 TATTOOIBODY PEIRCING 0 POOLISPA El LAND USE APPl:lCAT1ON 3TrE9 <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 13 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type($) of files from the list above by checking <br /> the appropriate box <br /> addresses <br /> At least one file type MUST be selected. Fax to (2091464-(1138 or mal(to the <br /> 7 <br /> addr ss Indlcated_ ov <br /> 2, EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed ! <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be meld for a maximum of five business days for review. Appointments should be scheduled . <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new t <br /> application may be submitted when the fila is available. <br /> 4. Any fie not returned in.'the same condition as released will be reorganized by EHD$tiff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.40 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be-confirmed with EHD staff. <br /> 6. Applications received after 3:44 pm will be processed the next business day. i <br /> f <br /> i <br /> CONFIRMED APPOINTMENT DATE _ TIME <br /> i <br /> DATE GQNf 1FtME[1 PHONE FAX INITIALS --- .k <br /> r <br /> REVIEWED YES NO REVIEW DATE <br /> FH as a o,mnroo <br /> . F f <br />