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=,09/2004 10:23 FAX 209 94806?1 <br />0002/002 <br />DATERFGEJVEO <br />EMO LOG NUMBER <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />JUN 0 9 2004 ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />LNVIRUNME0 HEALTH STOCKTON CA '95202 <br />PERMIT/SERVICES (209) 4663420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPUCANT_ J t I S l BUSINESSIAGENCY <br />ADDRESS <br />PHON1= FACSIMILE'�I� <br />TENTATIVE+APPOINTMENT DATE 6 f ` DL"' TIME <br />(Please give 7 to 10 business -days from date of appllcatlon submittal) <br />CHECK BOX TO EXPED" REQUEST, 67,00 FEE <br />REQUIYST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE <br />FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />�DI F'tf 1 i4,r1L S7n �v�j 4 C.A vopwl - <br />G <br />owl) <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />iP UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ;2 SOLID WASTE FACILCiY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACIUTY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK.(MONRORING/REMOVAL) Q DOG KENNEL -�DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTELJHOTEL t7 PUMPER TRUCK/YARDICHEM TOILETS <br />❑ TATTOCYBODY PEIRCING © P00L1SPd Ind "LAND USE APPUCATION SMES <br />❑ MEDICAL WASTE FACILITY ¢1 PUBLIC WATER SYSTEM n 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 />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. applieatlon. 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 nen <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 $87.00 deposit prior to revlew <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 1]ATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE __ , <br />