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Aug 25. 2003 1 20P , COI EARTH TECHNOLOGIES No 4748 P. 1/1 <br /> DATE RECSVEG . <br /> EZd]LOG NUNbEp <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 2 < ��I1`1 304 EAST WEBER AVENUE, FLOOR NO� STgCK70NCA95202 <br /> 202 <br /> . (209) 468-3420 <br /> ci PUBLIC RECORDS RELEASE APPLICATION <br /> -� <br /> APPL:CAN7 Q_p,� � � `Z_BU31NEss/AGET(CY <br /> ADDRESS <br /> PHONE ���+� FACSIMILE <br /> TENTATIVE=APPOINTMENT DATE 9 U TIME <br /> (Please Sive 7 to 10 business d4.0 from date of appilpUon submitia)) <br /> • <br /> CHECK BOX TO EXPEDITE R£t1VES7-$87.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS ' -7- <br /> SIGNATURE OFAPPLICANT <br /> 7,SIGNATUREOFAPPLICANT I� t� P� DATE 25 07j a3�d�•�� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PR9G E NTS SEARCH <br /> ::120 Saki SaaAv oc {L1rov� ✓ • <br /> Ave,' <br /> St K <br /> r <br /> J <br /> �^ O ✓ /� <br /> 12 <br /> F l <br /> vLa ✓ <br /> ENVIRONMENTAL HEALTH OMSION FILES ^ , <br /> UNDERGROUND TANK(UST) CLEANUP SITE(LOP) In HOUSING ABATEMENTSOLID WASTE FACLTY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONL70RING4REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARO/CHEM TOILETS <br /> TATT00/80DY PEIRCING ❑ POOU3PA - ❑ LAND USE APPLICATION STIES <br /> MEDICAL WASTE FACILITY X PUDLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List up to ten addresses in the space above.'Seleci4 type(s) of flies 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 malito tLie <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 01prIpre6l' <br /> 5. 'TENTATIVE appointment dates must be-confirmed with EHq staff. <br /> 6- Applications received after 3:00 pm will be processed the next business day. 17. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br />