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SAN JOAQUIN COUNTY "J <br /> ENIONMENTAL HEALTH DEPARTNT <br /> uw EAST WEBER AVENUE, THIRD FLOOR <br /> JUN 1 :S 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> _ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT(�)I�U' FS � <br /> �� /"''k BUSINESSIAGENCY <br /> IV /K /➢F r LGJ c� `, <br /> ADDRESS S6 _ �, ,,, /ice <br /> PHONE L�6 3 7 9a 7 L( FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89. E-REQKST PROCESSED IN 3 BUSINESS DAYS w�I I 3'� <br /> SIGNATURE OF APPLICANT {VVV/�TEE���. ` <br /> DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> S� E PROGRAM ELEMENTS SEARCH <br /> Lp <br /> r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> -0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> LfJ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> Ca UNDERGROUND TANK(M ONITORINGlREMOVAL) ❑ DOG KENNEL ❑ SOLID WASTE VEHICLE <br /> W HAZARDOUS WASTE GENERATOR ❑ ❑ DAIRY <br /> ❑ TIERED PERMITTED FACILITY CHICKEN RANCH Cl PKG TREATMENT PLANT <br /> ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ MEDICAL <br /> WAS E FACILITY <br /> ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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. 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 $89.00 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 /> =4"2406 <br /> E TIME <br /> PHONE FAX <br /> INITIALS <br /> NO REVIEW DATE <br /> 3126/2003 <br />