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07/10/00 Mort 16;10 FAX 2011 ()b:-, L , . ,lil wiAiAl-Nlu ��j 0U[ <br />Tu <br />1'rer4294IG2 P. 432 <br />SAN JOAQUIN COUf1TYPUBLIt^ HEALTH SERVICES <br />cHouaeeninwea <br />AUG 2-9 2000 <br />ENVIRONMENT HEALTH <br />PFRMIT/S�RICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR +4 <br />STOCKTON CA 95202 k y <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />RUSINESSIAGENCY <br />FACSIMILE <br />10 TENTATIVE' APPOINTIOW-NT DATE TIME <br />(Please give 7 to to buain*ss days from data of oppliration submittal) <br />90<,.PHECK BOX TO EXPEDITE REQUES�- SMOQ_,FF,rE- <br />SIGNATURE OF APPLICANT <br />PROCESSED IN 3 BUSINCSUDAYS <br />DATE <br />f <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOU31140 ABATEMENT <br />$i SOLID WASTE FACILITY <br />�l OTHER CLEANUP SITF& (NON -LOP) <br />'21 <br />O FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />�d <br />UNDERGROUND TANK (MONITORINGiREMOYPl) <br />Cl DW KENNEL <br />DAIRY <br />I HAZARDOUS WASTE GENERATOR <br />❑ CHCKI=T1 RANCH <br />:. � .G�I�r• .'�'�llrC+Vir"71,�i�r .:�' .��iC1l��►'��� <br />$I TIERED PERMITTED PACILFTY <br />O MOTEUNOTEL <br />)0" PUMPER TitUCKIYARD/CHEY TOILETS <br />❑ TATTO01500y PIERCING <br />O POOLI8PA <br />,4 LAND u3E APPLICATioN srrEs <br />O MLDICAL WASTE FACILITY <br />O PUBLIC WATER SYSTEM <br />M OTHER (PLI=ASE SPECIFY ABOVE) <br />Iwo FMA <br />3 _ List up to ton addresses in the space abova. 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 (om) 404:013M or mail to the �r— <br />addrass Indicated abQve, <br />2. EHD will notify the applicant If any EHD files exist. An appointment for roview will be confirmed <br />approximately five business days but no later than ten (10) days after recelpt 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 now <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorfaanixed by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />b. Applications received after 3:00 prn will be processed the next business day. <br />CONFIRMED APPU NTMENT DATE <br />DATE CONFIRMED <br />REVIEWED <br />[M 00 71 D7 <br />YES NO <br />TIME <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />TCTRL P.02 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOU31140 ABATEMENT <br />$i SOLID WASTE FACILITY <br />�l OTHER CLEANUP SITF& (NON -LOP) <br />'21 <br />O FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />�d <br />UNDERGROUND TANK (MONITORINGiREMOYPl) <br />Cl DW KENNEL <br />DAIRY <br />I HAZARDOUS WASTE GENERATOR <br />❑ CHCKI=T1 RANCH <br />X PKG TREATMENT PLAIT <br />$I TIERED PERMITTED PACILFTY <br />O MOTEUNOTEL <br />)0" PUMPER TitUCKIYARD/CHEY TOILETS <br />❑ TATTO01500y PIERCING <br />O POOLI8PA <br />,4 LAND u3E APPLICATioN srrEs <br />O MLDICAL WASTE FACILITY <br />O PUBLIC WATER SYSTEM <br />M OTHER (PLI=ASE SPECIFY ABOVE) <br />3 _ List up to ton addresses in the space abova. 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 (om) 404:013M or mail to the �r— <br />addrass Indicated abQve, <br />2. EHD will notify the applicant If any EHD files exist. An appointment for roview will be confirmed <br />approximately five business days but no later than ten (10) days after recelpt 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 now <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorfaanixed by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />b. Applications received after 3:00 prn will be processed the next business day. <br />CONFIRMED APPU NTMENT DATE <br />DATE CONFIRMED <br />REVIEWED <br />[M 00 71 D7 <br />YES NO <br />TIME <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />TCTRL P.02 <br />