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©�-ca-2001 11:Ur qM FT TO 401916:;645633 P,01 <br /> ._.._ "p L04 NUdli4Mj <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES I I ' <br /> i ENVIRONMENTAL HEALTH DIV1510N <br /> 304 EAST WEBER AVENUE,THIRD FLOOR C, <br /> STOCKTON CA 55202 <br /> (209)468.3420 y <br /> 'IPPBL,IC RECORDS RELEASE APPLICATION <br /> APPLIOANT FtgBUSINE9srAGE�NCrY t�+.l�.� FSE <br /> ADDRES(S$� ID},U_ Qcc k,�-•i��.--ti Ate, Sac•a....a,,.� <br /> PHONEIIA) �6 y-SSa. Ylxx32 FAcsIdnLE �/6 3G�`'SE3-3 <br /> TENTATIVE"APPOINTMENT DATE Yfs o TIME 13:abA a <br /> ivIft <br /> (Pt "Q 9iv97 W 17 hu IA9$s dfrau date frdate 01eppli"a w submittal) APR — n <br /> n-'CH-ECK BOX TO EXPEDrrE REQUEST•347M FE!-R11QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Q. ( & DATE IIIA4-! <br /> _ I _ <br /> FIL ADDRESS THIS SIDE EHD 5TAFFUSE ONLY <br /> T PRgGRAM ELEMENTS 5EARCH O <br /> 1 <br /> i <br /> I 'rh <br /> (f I I I ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK{UST)CLEANUP sn'E(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(tJON-Ldp) C1 FU00 FACILITY ❑ SOLID WASTEVEM= <br /> UNDERGROUND TANK(MONITQRINWREMOVAL) M DOG KCNNEI 0 DAIRY <br /> Cr HAZARDOUS WASTE GENERATOR 0 GHICHFN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIEREp PERM77ED FACILITY ❑ MOTE KOTEL U P(IMPEATRUCKIYAROfCHEM TOILETS <br /> 17 TATTOOIBODY PEIRCINO 0 P60USPA '' O LAND USE APPLICATION SITES <br /> 3 MEOICAL WASTE FACIUTY 'CT PUBLIC WATERSYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addrssee In the space above. Select the typa(s)of files from the list above by checking <br /> the appropriate boz(es). At least one fila type MUST ba selected. Fax to(209)464-0135 or mail to the <br /> address indlcajad�42M <br /> 2. EMD will notify the appllCant If any EHD files exist, An appointment for review will be confirmlad <br /> approximately flve business days but no later than ten(10)days after receipt of application.-The rifles <br /> witl be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A the that Is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be Iaubmitted when the file is available. <br /> 4. Any file not rptumed In the mama condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Fyture file reviews by the same applicant may require a $87.00 deposit prior to rovfew. <br /> 5. "TENTATIVE appoitltment dates must be confirmed with EHD staff. <br /> fi. Applications received after 9:00 pm will be processed the nest business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES I NO REVIEW DATE <br /> 00 {4 .lem7�pp <br /> TCrrAL P.01 <br />