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09/177//2,003 09:36 FAX 209 9480671 0002/004 <br /> MTE P£C�EO - '_ ' ENO LOG NUY9EA <br /> �.� ;r, 71 ;, SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 107 ENVIRONMENTAL HEALTH DIVISION304 EAST WE6ER AVENUE,THIRD FLOORSEP 17 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> pi g�P1MENT NtA HPUBLIC RECORDS RELEASE APPLICATION <br /> D n lv I 1' <br /> APPLICANT K-� I S i C( :,S BUSINESSIAGENCY �L'F' L.pl(h�--ZU-2 <br /> ADDRESS <br /> PHONE 209 /--7Lfa/ 1.391 (F'ACSIMILE 209 /9'fn juA ZI <br /> TENTATIVE'APPOINTMENT DATE -( J2� (V� nM6 t Zuo <br /> (Please give T to 10 business days from date of application suum ttal) <br /> CHECK BOX TO EXPEDITE REQUEST•S T.00 F —REQUEST PROCESSED IN 3 BUSINESS DAYS ' I <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THLS SIDE EHD STAFF USE ONLY <br /> PROGRAM FL.EMENTS SEARCH <br /> 23 _ t 7V A ^s• <br /> 2 T tJ. CA. I P( Y <br /> LIC1 w tt Ir Inirnil <br /> Ir <br /> VCI L,' i <br /> ENVIRONMENTAL HEALTH DIVISION FILES { . r <br /> r • ,�i,� ' lIr <br /> nb UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 31 SOLID WASTE FACILITY i I-�"�•' <br /> R OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL Da DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IQ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA - ' P LAND USE APPLICATION SITES <br /> ❑ MEDICAL 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 rile type MUST be selected. Fax to(20914 4-013 mallto 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 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 /> REVIEWED YES NO REVIEW DATE <br />