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09/17/2003 09:37 FAX. 200 9480621 <br /> 004/004 <br /> carE <br /> SAN JOAQUIN CCUNTYPUBLIC: HEALTH SERVICES EROLOGNu <br /> ENVIRONMENTAL HEALTH E)IVISION <br /> 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> S I P 1 7 2003 STOCKTON CA 95202 l <br /> (209) 468-3420 <br /> T tJEAU-H PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT -]I Q7, Ap, BUSINESSIAGENC7'_ <br /> ADDRESS <br /> n� <br /> PHONE Zoc <br /> I G `fl l 3aFACSIMILE D'I 0 6 r �1 J <br /> TENTATIVE"APPOINTMENT DATE Q TIME <br /> (Please QIYe 7 to 10 buslpess days Srvm date of application submittal) <br /> awfiw <br /> CHECK BOX TO EXPEUITL REQUEST.$87.00 F QUEST P E5SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE '5 �Lt <br /> FILE pbDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS StARCH <br /> L4 R 1s_ L <br /> 0 J S� ,, • <br /> L{L Ir rr <br /> i` rI <br /> W 1 l_%n� _WA`! t e - <br /> � <br /> 32 <br /> 1y tr <br /> �3 c7 d Vj) 1 :f1' h ,Z.-�—t f 111' �Iyr; <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �A UNDERGROUND TANK(UST)CLUNUP SITE(LOP) 0 HOUSING ASATEMIvNT 0 SOLID WASTE FACILITY 4 <br /> f?-1 OTHER CLEANUP SITE(NON-Lop) o FOOD FACiLR'Y 13 SOLID WASTE VEHICLE <br /> q UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 61 DA]RY <br /> 9 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IH PKG TREATMENT PLANT <br /> 4 TIERED PERHIn-mo FACILITY p MOTEUHQTEL ❑ PUMPER TRUCKITARDICHEM TOILETS <br /> 10 TATTOO(BOOYI"VIRCING ❑'Ep,puzpA R-LINO USE APPLICATION SITES <br /> ❑ MEDICAL-WASTE FACILITY C1 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tett addresses In the space above. Select the type($) of files from the list above by Checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 64-0138 or mail to the <br /> ddress Indicated above <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for revlew will be confirmed, <br /> approximately five business days but no later than ten(7O)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, Anew <br /> appiiCatlon may be submitted when the file Is available. <br /> d- Any file not returned in the same Condition as released will be reorganlzed'by EHD staff at the expense <br /> of the applicant, Future file reviews by the same applicant may require a$13TOO deposit prior to review. <br /> 5. 'TENTATIV'E appointment elates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next buslness day.' <br /> CONFIP.MED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INnJALS <br /> REVIF-WED YES NO REVIEW DATE <br />