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UU1 c1�1 wuJ 1e. Ul 404al 3a LNV1KUNMENIAL HLALIH PAGE 01 <br /> DATER"eCENED <br /> r�� CI SAN JOAQUIN COUNTY <br /> M� 1��' r. ENVImuAMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> AUG 1 6 2004 STOCKTON - 9 ( IC5 <br /> �\s L.1 <br /> lip <br /> (209)468.334200 \��C`J � <br /> r', PUBLIC RECORDS RELEASE APPLICATION <br /> PERNIM'S ;J ._, ms nh <br /> APPLICANT-) f-A \1vx�S-2� BUSINESSIAGENCY ^ 3 e � <br /> 9 <br /> ADDRESS \���1 �-��• S'r _\�t1�J G`S:S�_: C.'� <br /> PHONE L O"\ c 2'L `1 \\C� FACSIMILE Z u S ZZ- ' ( LZ' 7 <br /> v:w \\ S c <br /> \Q <br /> TENTATIVE*APPOINTMENT DATE S---\SQ �� TIME <br /> � S ��-p��— <br /> (Please give 7 to 10 business days from date of application submittal) Lo 0 <br /> � qCHECK BOX TO EXPEDITE REQUEST-S�FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE 2 1 <br /> 'SIGNATURE OF APPLICANT �'` ` ��' `� <br /> 4 <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH �Vg <br /> Lo0'I `� 1 <br /> �k a c a C" LMZ <br /> ' <br /> L I(, <br /> \y �y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 10 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT [3 SOLID WASTE FACILITY <br /> SOLID WASTE VEHICLE <br /> 110 OTHER CLEANUP SITE(NON•a 017) ❑ FOOD FACILITY ❑M DAIRY <br /> lb UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ PKG TREATMENT PLANT <br /> SI HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPER TRUCK/YARDJCHEM TOILETS <br /> D TIERED PERMITTED FACILITY Q LjOTEUHOTEL <br /> L) POOUoLiSPA Q LAND SE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCING �p (PLEASE SPECIFY) I a <br /> El MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. ointment for review will be confirmed <br /> 2. EHD will notify the applicant If any EHD files exist. An app lication. The files <br /> approximately five business days but no later than ten (10) days oier ntment sshou dpbe scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. available for review. A new <br /> 3. A file that is actively being worked on by EHD staff may not be immediately <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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5, 'TENTATIVE appointment dates must be confirmedwith <br /> the next business da <br /> 6. Applications received after 3:00 pm will be processy' <br /> FDATECONIFIRMED <br /> NFIRMED APPOINTMENT DATE <br /> TIME <br /> PHONr- FAX INITIALS <br /> REVIEWED �YES I^/ NO / REVIEW DATE g <br /> anerzooa�D"G t , cJ��� /C I �! °�v �G• �3j A`� u- <br />