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NOR Envirormentdl %w PHONE NO. :, 209 369 4228 Dec. 03 2002 02:54PM P2 <br /> Ftflp'�I eNo tioc auMaErc <br /> "IE HECENEUD _ <br /> FED) ' 'JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 0&5 <br /> DEC 0 3 2002 v 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> i:.NV OONI )ENT IiFa�TH <br /> (209)468.3420 <br /> Prc,_" / FRVIICPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Y5•$ri yyV <br /> �—FP.�--C.��..Cw-17d � BUSINESSIAGENCY Nati ENV)�NIMENTAL' <br /> 1 <br /> ADDRESS Z7+ TrU<JS 1UI� - LO-DI <br /> PHONE (?yj) _441- FACSIMILE (zpq) 3[09 �2�8 <br /> I7.•- 12_^ 67- TIME I�•• d'O Q1M. <br /> TENTATIVE'APPOINTMENT DATE <br /> (please give 7 to 10 business days from dat@ bt application submittal `J ;1c^Jt✓J <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 YS <br /> SIGNATURE OF APPLICANT f` <br /> DATE <br /> FILE ADDRESSTHIS SIDE EHL STAFF USE ONLY <br /> L-04; `j5v'm PROGRAM ELEMENTS SEARCH <br /> ' i'�d29 hl•Gvi Avt. la-ss5 N. 6-v�ld <br /> v cVIA" W <br /> (220 %CA ` <br /> D <br /> VA. <br /> ~� <br /> V Vh 8g _ <br /> • Civ A � <br /> 4l E. C <br /> '1`vrwc.v Rd. <br /> ENVIRONMENTAL HEALTH DIVISION FILES t/)� <br /> S c v not}S <br /> Q( UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C] B <br /> HOUSING AATEMENT O SOLID WASTE FACILITY Ll SOLID WASTE VEHICLE <br /> � OTHER CLEANUP 517E(NON-LOP) ❑ FOOD FACILIYY <br /> M 11 DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK ORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> D1 HAZARDOUS WASTE GENERATOR ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARWCHEM TOILETS <br /> VO TIERED PERMITTED FACILITY ❑ POOL/SPA <br /> O LAND USE APPLICATION SrrES <br /> OO <br /> ❑ TATTOOIBODY PEIRCING Li POOLIC WATER SYSTEM tti, OTHER(PLEASE SPECIFY ABOVE) <br /> Li MEDICAL WASTE FACILITY - <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 filo is available. <br /> 4. Any file not retumed in the same condition as released will be reorganized byEHD staff at the expense <br /> of the applicant. Future file reviews by the some applicant may require a$89.00 deposit prior to review. <br /> 5, <br /> *TENTATIVE received after 3:00 pm will be pro es ed he next ment dates must be confirmed with business day. <br /> 6. Applications <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATECONFIRMEO -PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />