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DATE RECEIVED SAN JOAQUIN COUNTY <br /> �-:JI J F,DD ENVMONr4ENTAL HEALTH DEP.ARTivIENx <br /> 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> 0 C T ® 4 2004 <br /> (249)468-3420 Fag:(209)464-413 a :. "co.san-joacluxn•ca•us/ebd oro55 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PER Ni1ilSERVIC S j <br /> APPLICANT.—NAA �i aUSIN ctt: . <br /> ADDRESS: <br /> PHONE! 7.oR"9� S6D _FACsIM • <br /> TEM'ATIYE* ENT DATE: Ttme: <br /> (Please allaw 10 badness of aPAIk*Iw subM" <br /> ® CHECK BOX TO EXPEDITE RE EST-$x"00 FEE—.RWZUtST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'V DATE ,Z; <br /> DOPWbrifflA Use Only <br /> uNtl' <br /> 1211.2 ADDRESS <br /> ,• ate« D Unit 9 <br /> z s (a <br /> s. s , ❑ Unit 2 <br /> e. $" <br /> s ❑ Unit 3 <br /> ` ❑ Ung 4 <br /> T. <br /> s. ❑ Unit 5 <br /> CW <br /> c <br /> �o. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES • <br /> D HOUSING 'fEMfENT ® SOLID WASTE F <br /> O UNDERGROUND TANK(US'q CLEANUP SITE(LOP) d D F <br /> D OTHER CLEANUP SITE(NON I OP) D SOLID WASTE <br /> EI DAIRY ®Q� <br /> d UNDERGROUND TANK(MOHIroRINGrREMOVAL) Q �V. <br /> HAZARDOUS WASTE GENERATOR DOG NENNEL 4 PKG'IREATMENT PLANT <br /> PERMED FACILITY ® MO O PUMPER TRUCKt1PARDICHEM TOKErS <br /> Q TIERED TIERED 60�1Y i�ERCTNG .® A Q LAND USE APPLICATION SITES <br /> D <br /> i <br /> E3 MEDICAL WASTE FACB.ITY <br /> 1. list up to ten addresses in the space a e- Select the tyl*sj of files from the Clst aboye by checking <br /> the appropriate bo�c(es}, At Least one fie MUST be selected. Fax t209)46"138 or mailto the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files 'st. An appointment for review will be confirmed <br /> approximately five business days but no laterten 0e days after receipt of should <br /> be scheduled The files <br /> will be held for a rna)6mum of five busin for review. Appointments should be scheduled <br /> accordingly. <br /> Anew• <br /> 3. Afile that is actively being worked on by EH15 staff may not be immediately ayallable for review. <br /> I 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$93.00 deposit prior to review <br /> .5. 'TENTATIVE appointment dates must tie confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will bd processed the next business day. <br /> !CONFIRMED APPOINTMENT DATE 'EINE <br /> ONE 'INITIALS <br /> DATE CONFIRMED .•.:; <br /> i <br /> REVIEWED YESNO ]_ REVIEW DATE: <br />