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UU1 G.ir LUUj 1 f . U1 <br />OATS RECEIVED <br />AUG 16 2004 <br />,1. <br />LhIN14R11NM1Pt'+I 1 <br />404UIZC <br />ENVINUNMENIAL HEALTH <br />PAGE 01 <br />& <br />SAN JOAQUIN COUNTY <br />ENVIR' MENTAL HEALTH DEPARTMEN i <br />0 <br />304 RAST WESER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) x#68.3420 �� � t1 a Z • I <br />PUBLIC RECORDS RELEASE APPLICATION <br />PER��IiI� ! :z..,: ] <br />APPL,ICANT�Zc�C` �� ��� 13USINES5IAGENCY � - ^ -,- D�\ <br />3 Sic Hr� tS <br />ADDRESS <br />PHONE z V 22— 1� FACSIMILE <br />v 'A\ Sc.hZi, \'\� <br />TENTATIVE* APPOINTMENT DATE 'C)n Cts k ; \2 1 TIME <br />(Please give 7 to 10 business days from data of application submittal) <br />LW <br />CHECK SOX TO EXPEDITE REQUEST - S . D FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS l <br />SIGNATURE OF APPLICANT DATE $ 2 <br />ENVIRONMENTAL HEALTH DIVI$ION 'FILES <br />2 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />111 OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ Sm AD wASTE VEHICLE <br />'S UNDERGROUND TANK (MDNITORINGIREMOVAL) ❑ DOG KENNET, ❑ DAIRY <br />04 <br />0 HAZARDOUS WASTE GENERATOR CHICKEN RANCH ❑ PKG.TREATMENT PLANT <br />d TIERED pERM[TTED FACILITY MOTELIHOTEL 171 PUMPER TRUCKfYARDICHEM TOILETS <br />* TATTOOA30D'Y FEIRCING O POOLiSPA CI LAND USE AFPIJ ATION SITES f <br />❑ MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) I' <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checlsin <br />the Appropriate box(es). At least one file type MUST be Selected. Fax to (2091464-0138 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 fifes <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 FHD 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 $89.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be confirnled with EHD staff. Alm <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRME'D APPOINTMENT DATE TIME - <br />DATE CONFIRMED PHONI= pAX INMALS <br />REVIEWED-�Y�jE/�S �� /� NO <br />REVIEW �DATE Af� <br />