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W7Mar. 5. 2002 5 0 7P CrAnOR EARTH TECHNOLOGIES V� 0 V No. 8600 P. 2/4 0 /uAiE RECOVED .wEMO LOG NGMaER SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 904 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 7 02 Mt' I' -`i P� (209)468-3420 �bE991C RECORDS RELEASE APPLICATION APPUCANT,._QQ,_1,_ BUSINESSIAGENCY 1 Q .�• �z r•�-1� �[��h ADDRESS �•�•�,r� PHONE . 1• I� 7�- FACSIMILE 'cE�• TENTATIVE' APPOINTMENT DA E F'�itX C' h D 2� .TIME A~ r ❑ �Ple�;ve 7 0 6usin ,�am 9INSSINESS appon submittal) CHECK BOX TO EXPEDITE RE� - ;87.00 FEE - OCE DAYS �I ' L SIGNATURE OF APPLICANT 1 � X "4_� DATE: SMGWO2 FRE ADDRESS THIS SIDE EHD STAFF USE ONLY PROGRAM ELEMENTS SEARCH , � � w � S: .. _1111111-IIIIIIIIIIIIII�IIIIIIIIIIIIII, SIt� IIIIIIIIIIIIII" . • � �II_I_I1111111111♦11�1� fNDERGROUND TANK (UST) CLEANUP SITE (LOP) _.' _►...� SOLID • 0 FOOD FACILITY❑ Miff" a.1 •�.�•. :� ! 1111111111-�,1 r J,iNDERGROUND TANK (MONITORINGIREMOVAL) . ��1�IIIII��AIUJC�1-7111: �III�A "ATARDOUS WASTE GENERATOR O'CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY 0 MOTELMOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS 0 TATTOO/BODY PEIRCING ENVIRONMENTAL HEALTH DIVISION FILES 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0:u8 or mallto the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHO staff may, not be Immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a $87.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS WASTE FACILITY fNDERGROUND TANK (UST) CLEANUP SITE (LOP) 17 HOUSING ABATEMENT SOLID Ca' nqTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY❑ SOLID WASTE VEHICLE r;t'OAIRY r J,iNDERGROUND TANK (MONITORINGIREMOVAL) E] DOG KENNEL "ATARDOUS WASTE GENERATOR O'CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY 0 MOTELMOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS 0 TATTOO/BODY PEIRCING M POOLISPA - - CI LAND USE APPLICATION SITES ' lg MEDICAL WASTE FACILITY ❑ PUBuc WATER SYSTEM C7 OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0:u8 or mallto the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHO staff may, not be Immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a $87.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS