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-FRO-1 : NOR Environmental �ftw PHONE NO. : 209 369 4228 _ Dec. 03 2002 02:54PM P2 <br /> ono Soc nun aea <br /> uAIE HFCEIVEe <br /> JOAQUIN COUNTYPUBLIC HEALTH SERVICES � <br /> nl '•�� 11� ENVIRONMENTAL HEALTH DIVISION <br /> DEC 0 3 2002 v 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 J <br /> ;:.PJV'sR0(dMEPiT IiEALTH <br /> (209) 468.3420 <br /> Pf'RN11T/SFRVICF.AJBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Ar'551 12-PIC-C-0 � , t�� BUSINESS/AGENCY tjDA" ENVIP_0NMCrJ1'AL.. <br /> ADDRESS) Z Z TT v L1 S TU-N ` " - LM t \ p I I <br /> PHONE IZol) 4'4-�'-�'`}� FACSIMILEtog <br /> 1 10'•IS'o d`h"' <br /> TENTATIVE*APPOINTMENT DATE IZ-- ?- - G'L - TIME <br /> (Please give 7 to 10 business days from data of application submittal J <br /> 13 CHECK BOX TO EXPEDITE REQUEST•$89.00 FEE-REQUEST PROCESSED IN 3 Nn fMYS <br /> SIGNATURE OF APPLICANT _� - DATE fZ-3^OZ <br /> FILE ADDRESS ' '1 THIS SIDE EHD STAFF USE ONLY <br /> tlogl �� PROGRAM ELEMENTS SEARCH <br /> ' 129 rl•Gvi Avt• Ixss� N. Gv;td <br /> "� 1 cmad FJ <br /> yv <br /> CIDP r <br /> ti Spy C1 ) <br /> v 133 B'- TV✓ � Rai. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK COST)CLEANUP SrrE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> iA OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 1� TIERED PERMrrTED FACILITY ❑ MOTEL/HOTEL <br /> 0 TATTOOIBODY PEIRCING - 73PLIW 0 LAND USE APPLICATION SITES <br /> 11 MEDICAL WASTE FACILITY ElPUBPUBLICC WATER SYSTEM ¢l OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up t0 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 /> 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 retumed 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 /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED -PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />