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Feb • 13 . 2003 2 02P CON[ EARTH TECHNOLOGIES No 2817 P I/ 1 <br /> "W LOG HUMER <br /> DATE REMV �-1�,.,{-.i: •,, _ (f-� <br /> ISDN JOAQUIN COUNTYPUSLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> F E'B. 1 3 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 I I <br /> (209) 468-3420 <br /> RECORDS RELEASE APPLICATION <br /> C car <br /> u <br /> APPcANT e.-� BUSINESS/AGENCY- <br /> ADDRESS <br /> PHONE ^r�C FACSIMI E l <br /> r � �_, <br /> ,va�g-0-3 <br /> TENTATIVE"APPOINTMENT DATE a`{ tY{��o o Time �1 0-'V ._ <br /> (P1ea9e give 7 to 10 huaine4S days from date of application submMao 3q/5 <br /> 171 J I <br /> CHECK BOX TO EXPEDI'T'E REQUEST-387.00 F�--RVQUEST PROCESSED IN 3 BUSINESS DAYS V� n I <br /> SIGNATURE OF APPLICANT -T _ DATE <br /> FILE ADDRESSTHIS SIDF,END SYAFJ IT ONLY <br /> U 5T" ELEMEXIM SEARCH <br /> y �. Woo �,ua.r MA Ecfl no ✓sr ` __ <br /> i HV <br /> -711 Jt <br /> L- r <br /> t O ►b a»tom cam- 5e 4L 5 ✓ _ <br /> .;LO 6 96 5 art, CaC. fZ� �.� 1 VST ✓ �_ y <br /> S se. �, no v st -- <br /> goo h ✓ _ �� <br /> S `1 no V <br /> a d, P Dr io ✓ ✓ -- <br /> ENVIRONMENTAL HEALTH bIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE I;"cILITY <br /> OTHER CLE:-ANUP SITE(NON-LOP) 0 FOOD FACIIITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(NIONrrORINGlREMOVAL) ❑ DOG KENNEL DAIRY <br /> HA7AaDOUS WASTE GENERATOR W CHICKEN RANCH ❑ PKG TREATMEVT PLANT <br /> ❑ TIERED PERMITTED FACILITY d MOTELHOTEL Q PU&tpeR TRUC'KfYARD/GHENT TQILIw15 <br /> ❑ TATr•00/8ODY PEIRCING 0 POOL/SPA " ' �^LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFYAb0VE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the lkit above by chocking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to {209) 464_2138 Qr mail to the <br /> addres indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist, An appointment for review will ion confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The illE's <br /> will be hold 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 EHO 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 EHE) staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 doposit prior to review. <br /> 5. *TENTATIVE appointment dates must be-confirmed with END staff_ <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE __ _ _ TIME <br /> n A-rV nnk1c7r31fi=r% <br />