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LHU LUG NUMB,R <br /> � SAN JOAQUIN COUNTY <br /> 4 IRIECE]V IE[D) ENVfNMENTAL HEALTH DEPARTMEO <br /> 3 AST WEBER AVENUE,THIRD FLOOR <br /> APR 14 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ITI <br /> APPLICANT / I II'1 • CC( BUSINESSSIAGENCY <br /> ADDRESS D 3 G2 /I <br /> "'C C-�-FT✓f l�-t. �. r " • <br /> PHONE C6 -7,;x,1 - O Lf FACSIMILE_ � 2-a -& - r/O 1L� <br /> 4�� S7 - <br /> NT IVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> /91 CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYSmj <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Ic78 r « tr Ufa <br /> o rl r <br /> I 32 It ( r . r <br /> ( (I r H I Pi <br /> , �w . <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> rn OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID NIASTE VEHICLE <br /> �l UNDERGROUND TANK(MONITORING/REMOVAL) Cl DOG KENNEL )21 DAIRY <br /> VW <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 (209)464-0138 or 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 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 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 $89.00 depo tCiff <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. L'3 Z ;) rd <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> M ae-oz-0as <br /> zrzwzom <br />