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05/09/2003 14:48 9255517464 ENVIROFORENSIGS PAGE 01/01 <br /> DATE RECENEo <br /> e¢Ho LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> AY 0 0 X003 STOCKTON CA 95202 <br /> (209)468-3420 . <br /> �;J IPUBLIC RECORDS RELEASE APPLICATION <br /> -17 --- <br /> APPLICANT _BUSINESSIAGENCY �" - <br /> ADDRESS IIR'O7C- ub®ti p.�\yc1k A 2.Q , <br /> PHONE�Q��) 5'5j - '7g2 <br /> 2 FACSIMILE 62.S) SSI - ''ZG yi <br /> TENTATIVE"APPOINTMENT DATE TIME3 <br /> (Please glue 7 to 10 biAsIness dye from date of application submltial) <br /> Lj <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 LAA#1 1 QUEST PROCESSED IN 3 BUSINESS DAYS V-5t <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIDII EI-10 ST AFF USE ONLY <br /> PROGRAJN I LEW NTS SEARCH <br /> 1161 W <br /> ENVIRONMENTAL HEALTH DIVISION FILETS <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOL ID'NAS'lE FACILITY <br /> OTHER CLEANUP SITE(NONJ-OP) ❑ FOOD FACILITY C1 SOUD WAST E VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL Cl DAI;•.Y <br /> Q HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Cl PKC;TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY d MOTELIHOTEL El PUBIPE R TRUCKIYAIRD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA Cl LAN D USE AaPLIcAnON SITE,; <br /> ❑ MEDiCAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) ­­ <br /> 1. List up to ten addresses in the space above. Select the type(s)of files frorn the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax toL21J9L.54-U1<!6 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for r Iview 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. Appointme its should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EH❑ staff may not be(mmI)diat,ay available for review. A novo <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 E:-ID:staff at the expenseof the applicant. Future file reviews by the same applicant may require a $119.00 deposit prior to review. <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 day, <br /> CONFIRMED APPOINTMENT DATE: TIME <br /> DATE CONFIRMED PHONE FAX INIT1A LS _ <br /> REVIEWED YES NO REVIEW DATE <br /> 3rMZ®oa <br />