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✓v <br />QU/05/2002 14:08 FAX 209 948 KLEINFELDER <br />LouId1002/002 <br />OA ERECEIVFD EHD LHUM ER <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES j IP <br />ENVIRONMENTAL HEALTH DIVISION ]( <br />304 EAST WEBER AVENUE, THIRD FLOOR y6�—Dl V <br />STOCKTON CA 95202 I 38 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION j <br />APPLICANT of &eZ BUSINESSIAGENCY ����."•iY~P (�.rr' <br />ADDRESS '� / C a • <br />PHONE �7/f ���i� FACSIMILE y! <br />TENTATIVE" APPOINTMENT DATE �� �02. TIME //. .D0 <br />(Please give 7 to 10 business da from d e of application submktal) <br />Ni <br />CHECK BOX TO EXPEDITE REQUEST -S87.O�E—REQUEST OC 1IN�USINESS DAYS <br />SIGNATURE OF APPLICANT.�DATE 5 Gam_ <br />FILEADDRESS__ <br />I PROGRAM ELEMENTS SEARCH <br />IN <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />V <br />❑UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FA''CILITY <br />'yOTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br />MJ UNDERGROUND TANK (MONITORINWREMOVAL) ❑ DOG KENNEL ❑ DAIRY i <br />10—HA2ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKMARDICHEM TOILETS <br />❑ TATTOOIBODYPEIRCING ❑ POOLISPA ' ' Cl LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ 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) 4540136 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 EHDistaff 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 <br />DATE CONFIRMED <br />PHONE <br />TIME <br />I <br />FAX INITIALS <br />REVIEWED YES NO - REVIEW DATE <br />