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07i1:4/2003 08:05 FAX 200 9480621 /1002/002 <br /> EHO LW NUMBE0. <br /> nwrexec�lvEo <br /> l, SAN JOAQUIN COUNTYPUBLIG HEALTH SERVI(:ES <br /> ENVIRONMENTAL HEALTH DIVISION �Q <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 7`1/ <br /> ja 14 Z003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ <br /> •�� 1�`-r fi 7/'BUSINESS/AGENCY �le'•n'cG�2�- <br /> ADDRESS <br /> PHONE ���' �3�= FACSIMILE_ <br /> /moi � <br /> TENTATIVE-APPOINTMENT DATE TIME � ' <br /> (Please give T to 10 business days from data of application submittal) UA', <br /> /^ _ 2 <br /> + <br /> CHECK BOX TO EXPEDITE REQUEST-$87.0000 FFEEE-REQUE.5TT jPFZOOCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> gOQO o r3 _� c Slack ca • <br /> 095 <br /> VUL <br /> L <br /> I 'JUL <br /> f\��l <br /> Vv <br /> L <br /> V <br /> ENVIRONMENTAL HEALTH DIVISION FILES �J <br /> -,a-UNDERGROUND TANK(UST)CLEANUP STYE(LOP) C3HOUSING ABATEMENT OLID <br /> ID WASTE FACILITY <br /> ,OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY - f61AI WASTE VEHICLE1NOERGROUND TANK(MONITORING/REMOVAL) c3MENT PLANT <br /> nOG KENNEL DAIRY <br /> ,f-,HAZARDOUS WASTE GENERATOR 171 (71CHICKEN RANCH PKG TREAT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TA7Too[BODY PEIRCING ❑ OOL/SPA ' - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY .-G 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 4 -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 an by EHD staff may not be immediately available for review. Anew <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 <br /> by EHD staff 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 TIME <br /> DATECONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> of w 14 IM7M <br />