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0/2003 12:40 FAX 209 9480E - X002/002 <br /> DATE RECEIVED EHO LOCI NUABER <br /> SAN JOAQUIN COUNTYPUB[�IC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> UEC „ 200_ STOCKTON CA 95202 <br /> (209)468-3420 I & M <br /> �:�n. . ; , .;,;._; PUBLIC RECORDS RELEASE APPLICATION <br /> L r . Y <br /> APPLICANT bJ I PA 1 CTI-- S BUSINESSiAGENCY t-- i �- <br /> ADDRESS �1JO2S `L•�- `I� K 1�r� �' <br /> PHONE rIt{�/" tl y 7 FACSIMILE C�`'i <br /> S D iv I <br /> TENTATIVE`APPOINTMENT DATE 1 a�O TIME U� <br /> (Please give 7 to 10 business days from date of applicatlon submltta0 <br /> • <br /> CHECK BOX TO EXPEDITE REOUEST-Sa7.00 FEE— EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 0 1 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PI2OGRAm ELEMENTS SEARCH <br /> I} - <br /> LA— <br /> a 0 f__ <br /> IL <br /> Z 6 Ir. ►-•�• Lr t� �� <br /> V-17 <br /> S I ti ki <br /> ENVIRONMENTAL-HEALTH DIVISION FILi=S <br /> IF UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT JI SOLID WASTE FACILITY <br /> tP OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACIL[TY ❑ SAY WASTE VEMCLE Q <br /> � UNDERGROUND TANK(114ONI'TOR,INGMEMOVAL) ❑ DOG KENNEL )0 <br /> Et HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH PKG TREATMENT PLANT \O <br /> E3 TIERED PERMRTED FACILITY ❑ MOTELMOTEL PUMPER TRUCIC/YARD/CHEM TOILETS <br /> CI TATTOMODY PEIRCWG ❑•POOUSPX IR LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 1K PUBLIC WATER SYSTEM 13 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the W above by checking <br /> the appropriate box(es). At least one file type MUST be selected. ax to 209 464-0138 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 returned In the same condition as released will be reorganized by 1=HD staff at the expense <br /> Of the applicanL Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. "TEKTATIVi;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 /> DATECONFiRMED PHONE FAX INITIALS <br /> c i=%r:Fwgn YFG un RFviFw nnTF <br />