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MM_arr.• 5 . 2002 5 07P C OR EARTH TECHNOLOGIES No • 8600 P- -4/4 <br /> FtID LOG NV61aER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICE , <br /> I, ENVIRONMENTAL HEALTH DIVISION <br /> 304 FAST WEBER AVENUE,THIRD FLOOR <br /> ;K/ STOCKTON CA 95202 <br /> �1D Oz Wt R, -5 FN 4: Q (209)468-3420 <br /> 63LIC RECORDS RELEASE APPLICATION <br /> ^ <br /> APPLICANT�QQ,; � A47 BUSINESSIAGENC�Y C�x�dar f c- 1 es <br /> ADDRESS 1 Vy F -�.�� �t Y2j� . 5r1 a.1 4C--_,L_ <br /> PHONE � FACSIMILE v`J <br /> �/ • <br /> TENTATIVE*APPOINTMENT DATE 19 /1Xrl-) O"L TIME <br /> Pleas 1 7 to 10 bua`'M' 42!,J� 1da�te of a lied n sub Ual <br /> Id-M <br /> CHECK BOX TO EXPEDITE REQUEST $ �R£ UEST L65 I Y3) <br /> SIGNATURE OF APPLICANT DATE ��� O <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> LI v - N <br /> ) <br /> oo IVA1 <br /> i4.Ct 5 <br /> kd <br /> ✓ °f 3 e 1 <br /> 1273 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> r'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT C.I SOLID WASTE FACILITY <br /> b OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAGILnY �O LID WASTE VEHICLE <br /> t9r`UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL DYDAIRY <br /> 014'HATARDOUS WASTE GENERATOR CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> E"IERED PERMRTED FACILTIY q MOTELHOTEL 4 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/OODYPEIRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> M-191EDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM CI OTHER(PLEASE SPECIFYAbOVE) <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) 4e4-mo 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 hold 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 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 /> DATE CONFIRMED PHONE FAX INITIALS <br />