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D7/10/06 MON 16;10 FAX 209 :0621 L • > �;.�:i:1FaISh'a�? ,l JJ.: <br /> �a AY ti-�lr�i-i rrK TLI IY0742'34162 P-02 <br /> Yll� �L"71! 6 <br /> SAN JOAQUIN COUNTYPUBLIC HF-ALTH SERVICES :,....___.._ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AUg ZQflQ 3534 EAST WF_BER AVENUE,THIRD FLOOR r` <br /> STOCKTON CA 95202 <br /> EpIRON1\AENT HEALTH (zoo)468-3420.4PER �CES PUBLIC RECORDS RELEASE APPLICATION <br /> W <br /> r� rr <br /> APPL1�A1i�. btJFilttE&Ts1A(�ENCY <br /> �Y P}{�t,�'&" `! FAC51J5llILE f <br /> s • TI-NTATJVE'APPOINTMENT DATE TIS - <br /> (Pica*a give 7 to Ta bushvma day�s from data of apptirailnn subffalttal) <br /> CHECK f3C37L TO'EXPEDITE REQU _IMOD -RF- P..I;iT PROCESaLD IN 3 BtTSW.L'68't}riY'!. .:•6 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE at)VKCS:i <br /> JA- <br /> 1( <br /> yµ � 7 <br /> ENVIRONMENTAL}-HEALTH DIVISION FILES <br /> UNDL-ROROUND TANK(UST)CLEANUP 517E IL OP) ❑ WOU31NO ABATEMENT Vi 60UP WASTE FACII M <br /> OTHER CLEA14UP SITE(NON-LA)P) a FCOO FACILITY ❑ SOLID WASTE V12HICLE <br /> UNDERGROUND TANK(mow iTDRINGlRemoYAL) ❑ P()G KENKEL � 13A1RY <br /> I HAZARDOUS WASTe GENERATOR ❑ CM CK04 RANCH � PKG TREATMENT PLANT <br /> :EZ TIERED eERMITTED PACIUTY '❑ MOTEL *)TEL A"PumpaR TKVGKlYARWCHEU TOILETS <br /> ❑ TAT-1700 BODY FEIRCI14G C) POWSPA A LAND Use Appur-AT*w errEB <br /> 0 MLDICAL.WASTE FACILITY ❑ PUBLIC WATLtFL SYSTEM n OTHER(PLIWE SPECIFY ASOVPI <br /> 3_ List up to ten addresses in the space abOVQ. $vlact the type(s)of files from the list above by checking <br /> the appropriate box(ez). At least one file type MUST be salleated. Eijx 19 f2OQ) 4— <br /> adt#ress IndtZated abgV2, <br /> 2. EHL)will notify the applicant if any 'EHO files elcist, An appointment for review will be C-Onii rltied <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. AppolntrnLnts should be scheduled <br /> accordingly. <br /> 3. A fle that is actively being worked on by EHl3 staff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any file not retumecl 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 it$78.00 deposit prior to review, W <br /> 5- IrENTATIVE appointmant dates must be cordirrnid With EHD staff. <br /> 6, Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPQINTMF-N-T DATE TIME <br /> BATE CONFIRMED —„ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW nATE <br /> - <br /> TCTAL P.02 <br />