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Nellisa Kim <br />10 <br />818-3E.3-•83.1 F'-2 <br />0 <br />OAiE REGEN[O L I r_Hc. LOG M,N BE" <br />Ii SAN JOAQUIN COUNTY <br />ENVIRONMENTAL AEALTH DEPARTMENT <br />JUN 2, () Z003 304 EAST WEBER AVENUE, THIRD FLOOR I <br />STOCK] ON CA 95202 <br />.\riRijNA4(.Oi ii'LALiti (209',468-3428 <br />rwnSPtV1';;FS PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT,�I,I.2)�t. l�C. r BUSINES&AGENCY `I M L any iRxIL1'lf��=�:L�IIA�lOrl <br />ADDRESS IOyy 1 �Uf-�- r AVe . C-,(.j-rj-�C\A N -i11.5. A CI I <br />PHONE SI 6- ) 10 � -q C1 19 FACSIMILI: O (U - •J L ) - LI J L <br />TENTATIVE' APPOINTMENT DATE TIME <br />a (Please give 7 to 10 business C ays from date of application submlueq L4 �- <br />Vx CHECK BOX TO EXPEDITE REQUEST -589.00 FEE _REQU `T PROC SSED IN 3 BUSINESS DA:(S 1 , N I� <br />SIGNATURE OF APPLICANT C1AT1: ` <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />1 <br />❑ HOUSING ABATEMENT <br />❑ SOLID WAS715 FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />X UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ FOOD FACILITY <br />❑ N <br />❑ SOLID WAS 114 VEHICLE <br />10 <br />❑ HAZARDOUS WASTE GENERATOR <br />DOG ENNEL <br />❑ CHICKEN RANCH <br />DAIRY <br />❑ PKQ TREATMENT PL-AN1 <br />O TIERED PERMITTED FACILITY <br />❑ MOTEIJHOTEL <br />❑ PUIaPE:R TRI ICKrrARD/CHEM TOILETS <br />❑ TATTOOIBODY PEIRCING <br />❑ POOLtSPA <br />❑ LAIID USE Al IPLICA'DON SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />PECIFY)—.- <br />--.- <br />1. List up to ten addresses in the space above. Select the type(s) of files f-orn the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to D9Z !i4-01:; FI o r mail 01he <br />address Indicated above. <br />2. EHD will notifythe applicant If any EHD filei; exist. An appointment for I-eview (Jill be confirmed <br />approximately five business days but no later than ton (10) days after receipt of application. The files <br />will be held for a maximum of five business days for review. Appointment shi,uld be scheduled <br />accordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately ave. ilable for revievi. A now <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganl::ed by I:HD staff st the expense <br />of the applicant. Future file reviews by the same applicant may require it 189.01 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 d;ay. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />YES <br />TIME <br />PHONE FAX INITINLS <br />REVIEW DATE <br />