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.09/17/2003 09:37 FAX 209 9480621 X1004/004 <br /> DATE RECQVm ��� �� Eno I.OG HUM <br /> rrj, - I����,• r. ( SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 71�', ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE.THIRD FLOOR <br /> SEP 1 7 2003 STOCKTON CA 95202 f <br /> (209) 468-3420 <br /> _itivIF;UNMENT HEAI_l PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT [-��)l Sbi P�C�c FIS _BUSINESSIAGENCY <br /> ADDRESS <br /> PRONE loci 9�ico lid S „FACSIMILE6Z1 <br /> TENTATIVE"APPOINTMENT DATE �/D TIME /Z OLS <br /> (Please Blve 7 to 10 buslness days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-387.00 F QUEST PFrESSED iN 3 BUSINESS DAYS t i <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> d Z f}U t,.t E - <br /> ✓✓ G ..5- L <br /> t7 t) J <br /> c{L II rA �r Ir Q <br /> 19 31BIt tr <br /> 3 z N • W t_.%DA,.l WA T <br /> 3 inky E tr „ <br /> 1 o?, } A t AJL N , .r <br /> Z 11 rt <br /> `rr t.' !1+_x(.; tom( r11? -/ !�r� .�''/7J Ly <br /> ENVIRONMENTAL HEALTH DIVISION FILES ire <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMea 0 SOLID WASTE FACiLTTY f <br /> §� OTHER CLEANUP SiTE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> fA UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL Bi DAIRY <br /> Sd HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ® PKG TREATMENT PLANT <br /> ❑ TIERED PERMiiTED FACILITY ❑ MOTamoTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BOOYPEIRCING ❑•Pdotjgpq IZ LAND USE APPLICATIONan-Es❑ MEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 to(209)40-4,0138 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 receipt of application. The files <br /> will be held 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 <br /> application may be submitted when the file is available. <br /> 4• Any file not retumed 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 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE - <br />