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05/1,9/2003 12:00 17,�X 209 9480 I�]002�002 <br /> E1111 Loc nUYBFR <br /> con I j 4� n SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ( I I t'jJ ENVIRONMENTAL HEALTH DIVISION <br /> MAR 1 9 2003 304 EAST WEBER AVENUE,THIRD FLOOR Iq6 <br /> STOCKTON CA 95202 <br /> (209) 4663420 <br /> t-WRONIMEW HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT V 1T1 SIM L A--A BUSINESS/AGENCY <br /> ADDRESS 2f�7 <br /> PHONE J"jt'IK -11Ll '" FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE `Z9I D3 TRAE <br /> (Plaaso give 7 to 10 buslness day��---sfrom dale of appnl tion GubmlHal) <br /> 3q <br /> CHECKBOXTOEXPEOrrERLQUEST-507.00 E-REQUESTPROCESSEDIN3BUSWESSDA'f5 n• , ' <br /> SIGNATURE OF APPLICANT DATE 5-1 <br /> \ . FILE ADDRESS THIS SIDE EHL STAFF USE ONLY <br /> � PROGRAM ELEMENT:;SEARCH <br /> G f a Q r.L�) <br /> . LASS ) „p �/- <br /> 1 4 - <br /> 11tf cA s <br /> w_ Lo w t> anew <br /> P c31 <br /> .IE uaIc7aP cA I <br /> CA <br /> L c�At�,-- P'6- � L4 <br /> �.- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )$ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENTOt SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY -F SOUDWASTEVEHICLE <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL IS DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IF PKG TRFATMENT PLANT <br /> TIERED PERMITTED FACIL" O NOTELHOTEL .., W_PUMPER TRUCk1YARDICHEM TOILETS <br /> ❑ POOLISPA - ;A LAND USEAPPLI(tATK)N SITES <br /> ❑ MEDICAL WASTE <br /> ILI ❑ OTNER(PLEASESPECIFYABOVE) <br /> ❑ MEDICAL WASTE FACILITY ta-PUBLIC WATER SYSTEM ' <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. l=ax to t2t19] 464'138 or mail to ttte. <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD Tiles exist An appointment for review will LIC confirmed <br /> approximately five business days but no later than ten (10)days after receipt of apFllication. The files <br /> will be held for a maximum of rive business days for review. Appolntments 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. g Pnse <br /> 4. Any file not returned In the same condition as released will be reorganized b y EHD staff at the exp- <br /> of the applicant. Future file reviews by the same applicant may require it$87.00 d Iposit 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 �NfTIAL:i _ <br /> REVIEWED YES NO REVIEW DATE --_ __— <br /> a� a <br />