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06 20/2003 08:37 916341580^ SWRCB GQ BR PAGE 01/01 <br /> DATE RECENED etM LOG NLWMM <br /> �::., SARI JOAQUIN COUNTY <br /> _ ' .,;' '_. 1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> JUN 2 (� 2003 STOCKTON CA 95202 <br /> (209)468-3420 1434 <br /> -, _.� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ` f BUSINESSJAGENCY� <br /> ADDRESS <br /> PHONE 3"1 `' FACSIMILES �"[� i )Q <br /> TENTATIVE' APPOINTMENT DATE TIME f� M V T <br /> (Please give T to 1D b ineas days from dat of application su rnittali ' U <br /> CHECK SOX TO EXPEDITE REQ tS j-$89.00tFEF--REQU PROCESSED IN 3 BUSINESS DAYS <br /> 51GNATURE OF APPLICANT _ UATi:: � r <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRA14£LEME:NT$SI:ARCH <br /> - --- <br /> ff <br /> LP UIE <br /> eU <br /> .� <br /> OWNS <br /> !ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOL.ID'NA9'1 L-•FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) In FOOD F4CILITY Cl SOLID`NASI E VEHIf:I.E <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) Cl DOG KENNEL CI DAIRY <br /> Q HAZARDOUS WASTE GENERATOR O CHICKE•V RANCH Cl PKC.;TPEATAIIENT Pt.ANT <br /> C] TIERED PERMITTED FACILITY 0 MOTELIAOTEL L, PUMPER TRUCKfYAROMHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING t3 POOLlS PA C LAND USE A(PLICATION SITES <br /> O MEDICAL WASTE FACILITY O OTHER 'PLEASE SPECIFY)_—— <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. fax to.L2AI �I; �r mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD ides ox(st. An appointment for inview will be confirmed <br /> approximately five business days but no later than ten(10)days after revel pt of,application. The files <br /> will be held for a maximum of five business days for review. Appointments:sho uld be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be ImmgdlatEdy available'for ravleyr. 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 reorganiz.d by I:Ht3:staff at the expense <br /> of the applicant. Future file reviews by the sa me applicant may require�i$09.00 deposit prior to Review. <br /> 5. "TENTATIVE appointment dates must be coral irmed with EHD staff. <br /> 6. ApAlications received after 3:00 pm will be processed the next business day. <br /> C6k'FII''' F.6*APP0'INT--MEN"t ai0.11E <br /> : ... . <br /> ... . T <br /> DATECONFIRM o ` <br /> E :'PHONE... i�C .: .. ,. , Irall'lh l•�'iY'� <br /> -�EVIEWED . YES . NO • ..:....•, i2CVIIwWW DATE'.'. <br /> 3rmm <br />