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Dec. 03 2002 02:54PN P2 <br /> r-kal : NOR Environmental aal/ PHONE N0. : 209 369 4228 END a,oc Nwau <br /> JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC 0 3 2002 V 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> i`_PJVi"•O(J�IENT IiEALTH <br /> (209)468-3420 <br /> PFR; .11TISERVITUBLIC RECORDS RELEASE APPLICATION <br /> Ala84 F.AC.0-O BUSINESSIAGENGY tJDA" E'N`i�A t� <br /> APPLICANT —�--�-y,1 <br /> ADDRESS_7.7__ 4DJS 'TVQ L��l \ cf <br /> } <br /> PHONE (7^p1� L(.�.- �•4•� FACSIMILE (7.09) 30 <br /> - IZ^ OZ TIME <br /> TENTATIVE'APPOINTMENT DATE I mi la_11-0a�id ; <br /> (Please givaDAT 7 to'10 business days kom date of application submittal <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 YS ' <br /> SIGNATURE OF APPLICANT - & DATE <br /> FILE ADDRESS L_04i 510E EHL STAFF USE ONLY <br /> YS rrV PROGRAM ELEMENTS SEARCH <br /> 129 iJ•Gvi Avt. fa5s� N. Cry ld . <br /> _� I cYNw W <br /> ` �' 1220 ic•1vr <br /> ti 802 CI ) <br /> 4l E. %l, - <br /> v 133 6• Tvvww Rd. <br /> ENVIRONMENTAL HEALTH DIVISION FILES ) <br /> c C_ Yew wins <br /> ❑ SOLID WASTE FACILITY <br /> � <br /> �( <br /> UNDERGROUND ER NTANK(UST)CLEANUP 517E(LOP) 0 HOODING ABATEMENT OTHER CLEANUP <br /> ITE P S (NON-LOP) - ❑ FOOD FACILITY Ll SOLID WASTE VEHICLE <br /> UNDERGROUND TANK 0RINGIREMOVAL) ❑ <br /> M KENNEL <br /> HA7ARDOUS WASTE GENERATOR <br /> CHI 173 DAIRY <br /> TOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Irl TIERED PERMITTED FACILITY ❑ MO LIJHOTEE Cl PUMPER E APPLICATION SIM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ PUBLIC W ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ¢t OTHER(PLEASE SPECIFY ABOVE) <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 /> 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 deposit prior to review. <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_ <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO _ REVIEW DATE <br />