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ISG/�U/LUU4 11:06 FAA LUH U44U <br /> CVUZ <br /> o 'i! <br /> Lam"'� <br /> DATE RECv1 ,.1—i, �� . <br /> \J EHe LOG NUMBER <br /> X:N JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 3 0 2004 304 FAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRWG11',IFEI'fl HEALTH STOCKTON CA 95202 <br /> PERfv;!T/SERViCE )468-3420 <br /> NBLIC RECORDS�RELEASE APPLICATION �J <br /> I <br /> AIPUCANT- _ t'-'�-y (f� J 1t�1 �S BUSINESSIAGENCY F•�4-x'11-.91 T�I.VG�C� <br /> ADDRESS ZBZa � .' P�''C(2.�� &T <br /> PHONE FACSIMILE_ `�1 t't rC! �06 2, <br /> TENTATIVE*APPOINTMENT DATE �Ita�JN TIME I7. <br /> (Please give 7 to 10 business days from date of applioatlon submittal)/ <br /> CHECK BOX TO EXPEDITE REQUEST-;97,00 FAS—REQUEST OCESSED IN J BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6 Q <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 11D -IQ `f <br /> t LA. if Lt <br /> qf)o W — vklr C RO 11 ar <br /> P- <br /> 4�U aS LI ..4 <br /> I <br /> i <br /> i <br /> ENVIRONMENTAL HEALTHDIVISION FILES-7 <br /> ILES Dp / <br /> .I <br /> -7 <br /> 6� UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) IJHOUSINGABATEMENT M SOLID WASTE FAC14=- <br /> 19 OTHER CLEANUP SITE(NON-Lop) 0 FOOD FACILITY 0 SOLID WASTE VE141W a <br /> UNDERGROUND TANK(MONMOMNGIREMOVAL) 17 DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR D CHICKEN RANCH IR'PKG TREATMENTP <br /> t4 TIERED PERMITTED FACILITY O MOTEL/HOTEL .❑ PUMPERTRUG)CYARDIC <br /> ❑ TATTOOIBODY PEIRCING P POOLIsPA -" LAND USE APPLICATION SITES <br /> P MEDICAL WASTE FACILITY W PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. Ust 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 oi�mail to the <br /> address Indicated above.. <br /> 21 EHD will notlfy•the applicant if any EHD files exist. An appointment for review will be confirmed <br /> I approximately five business days but no later than ten(10)days after receipt of.application. The files <br /> I 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 nev <br /> I application may be submitted when the file Is available. <br /> 4I 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 /> T '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 />