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JMar . 5. 2002 5 :07PM C01"AOR EARTH TECHNOLOGIES No• 8600 P - V4 <br /> /GATE RE[ENEO E40 LOG Num"R <br /> I SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> '=NVIRONMENTAL HEALTH DIVISION <br /> ( ` <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 o <br /> 02 I')F I i -5 PI . (209) 468-3420 <br /> �6&JC RECORDS RELEASE APPLICATION <br /> APPLICANT---Q p, �/ �.PiIX�BUS1NESSIAGENCY Conjcr <br /> ADDRESS 1 V V V <br /> PHONE 7 FACSIMLLE ^ ^ -I <br /> A,�^,,, <br /> TENTATIVE'APPOINTMENT DATE Q 1-vet 6L— -nME <br /> ❑ _ (Ple�ujvs 7 0 6uy �a �to app on su4Rlittal} 1 <br /> CHECK BOX TO EXPEDITES RREE99" -$87.00 FEE- N SINESS DAYS A <br /> SIGNATURE OF APPLICANT DATE SMa 1-02 <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY O <br /> PROGRAM ELEMENTS SEARCH <br /> V 466 / <br /> 0. 1 <br /> O <br /> OI <br /> v <br /> h <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> CEJ NDERGROUND TANK(UST)CLEANUP SITE(LOP) 17 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> L� QTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACIL" ❑ SOLID WASTE VEHICLE <br /> ..7'�yNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL GZ/DAIRY <br /> CY�FIAZARDOU3 WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> D(TIEREq PERMI'fT�D FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> VATTOO/BOOY PEIRCING M POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM C7 OTHER(PLEASE SPECIFY ABOVE) <br /> i. 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 (7041 d64-0138 or mall-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 rile 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 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br />