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11U/.0/LUU4 11:06 tA1 LVU U46UUL1 W1 VVL <br /> l (J �\I <br /> �eN LOG Numom <br /> MTE REC4�'FU� `\% . <br /> `J XN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 3 0 2004 <br /> j 304 EAST WE6ER AVENUE,THIRD FLOOR <br /> I , <br /> STOCKTON CA'35202 <br /> Er,1VIR1jNI11'_-N!HEALTH (209) 406-3420 <br /> FER(v ITBERV10ENE30C RECORDS RELEASE APPLICATION <br /> i <br /> AiPLICAN7 NC-�I t BUSINESSIAGENCY —'— <br /> ADDRESS <br /> PHONE H� ' k3 FACSIMILE U�2 Z <br /> TENTATIVE*APPOINTMENT DATE I t D�d�{ TIMES <br /> (Please give 7 to 10 business days frortl date of applitatlon submittal) <br /> i <br /> ❑I CHECK BOX TO EXPEDITE REQUEST-SBTAtI F -REQUEST OCESSED IN 313USINESS DAYS <br /> 51GNATURE OF APPLICANT DATE 6 0 <br /> PILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Rij Z <br /> L{00 W — vk4Xee WO It .� <br /> P, tV w <br /> N <br /> it <br /> ENVIRONMENTAL HEALTH DIVISION FILES 7UNDqIO� <br /> 61 SOLD WASTE FACT <br /> d OTHERCLEAN07ANK(UST)CLEP.NUPSITE(LOP) 0 FOOD <br /> NT ❑ SOLD WASTE VEHICLE • /1 <br /> p OTHER CLEANUP SITE(NON�,OP) ❑ FOG KENNEL <br /> FACILITY 10 DAIRY _ (� <br /> [R UNDERGROUND TANK,(MONITORINGIREMOVAL) Q DOG KENNEL gT PKG TREATMENT <br /> �' HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH _❑ PUMPER TFtUCKIYARDlC <br /> a TIERED PERMITTED FACILITY O MOTELIHOTEL,.` [3 Fa LAND USE APPLICATION SITES <br /> ❑ TATr00IeODY PEIRCING 0 POOLSPA O LANDOTHEa PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY W PUBLIC WATER SYSTEM <br /> List up to ten addresses In the space above. Select the types)of,files from the list above by checking <br /> the appropriate box(es). At least one rile type MUST be selected. Fax to (20 9) 464-0138 ol�mail to the <br /> address indicated above.. <br /> 2 EHD will notlfy•t he 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 /> I accordingly. <br /> 31; A file that is actively being worked on by EHD staff may not be immediately available for review. A nev <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 deposit prior to review <br /> 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 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 /> REVIEWED YES NO REVIEW DATE <br />