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Ma• • 5 . 2002 5:07PM N'TOR EARTH TECHNOLOGIES No-8600 P- 4/4 <br /> ENO LOG NUMBER 3 <br /> SAN JOAQUlN COUNTYPUBLIC HEALTH SERVICE <br /> I; ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> fAR, —S FM 4: 02 . (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> -�— <br /> APPLICANT jE BUSINESS/AGENCY <br /> ADDRESS 18b <br /> PHONE FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE t61 /1X-e t k O—L— TIME <br /> (Please ive 7�%�� date plip ��dal) <br /> cHEcK BOX TO EXPEDITE REQUEST•SS .a0 FEE-RE L�S 3 B I AYs <br /> SIGNATURE OF APPLICANT DATE _s em t� O 2,- <br /> ME ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Y/ <br /> 1141 <br /> 14.E 5 <br /> V 17 3 e <br /> t 2 73 "61ya. L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Cr SOLIO WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITYLID WASTE VEHICLE <br /> 11 ;-UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL DAIRY <br /> (Er-HAZARDOUS WASTE GENERATOR O-CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> M-71ERED PERMNTED FACILrfY q MOTELIHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOO/BODYPEIRCING ❑ POOUSPA " - ❑ LAND USEAPPLICATIONSITES <br /> M4 191E0ICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFYAOOVE) <br /> 1. 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 L209)464-013$ ar mail 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 FHO 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 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 he confirmed with EHD staff. <br /> r. 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 />