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Mar • 5 . 2002 5 :07PM4 <br /> DOR EARTH TECHNOLOGIES . No. 8600 P - 4/4 <br /> EO _ EM LOC.NUMf9i <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICE <br /> i ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 02 I�P� _j FM : O? (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1�,Q ?X ,-I ' 1 9,_�.. BUSINEWAGENCY cc �Y.-lC_Jr �C'31!2��rlol 1 e j <br /> ADDRESS 1�7�••J fNi `1r[r 1��-Q..�?� �1� �.d,l - -�- <br /> PHONE } FAC9IMILE l <br /> TENTATIVE'APPOINTMENT DATE 161 RX/') 0-2— TIME +!!- =G <br /> Please6®Qir�e'7 to 10 bua`/merj 1'a date of a lica n sub et <br /> CHECK BOX TO EXPEDITE REQUEST $87.000,RE UE5T 4S 3 B S YS) <br /> SIGNATURE OFAPPL.ICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> VI <br /> ke <br /> folq <br /> MAH 2 i 2002 <br /> 11 v N <br /> ✓ o <br /> � a <br /> ENVIRONMENTAL-HEALTH DIVISION FILES <br /> ET'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT CI SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SrTE(NON-LOP) ❑ FOOD FACILI Y ❑ �OLln WASTE VEHICLE <br /> T*r-UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL DAIRY <br /> WHATARDOUSWASTE GENERATOR .Ig'CHICKENRANCH ❑ PKG TREATMENT PLANT <br /> M-TIERED PERMITTED FACILITY El MOTEL/HOTEL ❑ PUMPERTRUCKlYARD/CHEM TOILETS <br /> ❑ TATTOO/SODY PEIRCING 0 POOUSPA Q I.ANOUSEAPPLICATTONSTfES <br /> M�MFDICAL 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)464-0138 or mail to the <br /> address indicated above- <br /> 2. <br /> 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 fife not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant Future Nle 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 /> Is. 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 />