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03/ 9/2000 12:00 FAX 209 998062 10002"002 <br /> r_3 <br /> Elm LIYC eaa+eF,lt <br /> '9 /' SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR 1 9 2003 304 FAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-420 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ~`V ti✓tV 13USINESSIAGENCY <br /> ADDRESSrA <br /> PHONE _ FACSIMILE <br /> TENTATIVE*APPOINTMENT 3 Z1D3 _ TIME [Z7 3—�I— i f <br /> (Please give 7 to 10 business days from date of applIcatlon submMaE} <br /> CHECK BOX TO EXPEDITE REi�UEST-iIL7.00 E_REQUEST FROCF.,SSED iN 3 BUSINESS 0AV5 <br /> un + <br /> 3 i <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> fi <br /> FILE ADDRESS <br /> THIS 5106 EI♦D STAFF USE ONLY -- _ <br /> PROGRAM EL1rMENT:1 SIJARCH <br /> i3 �. EO <br /> tem �� _a, <br /> t 4 <br /> to O <br /> w- Lay.« JP C.A -- <br /> L .JL uh"WtaP <br /> :J POE- �, x• i <br /> 0. t lA,w%s fL Pn* Vtt--�NaP CA — <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Ot SOLID WASTE FL4CIIJTY i <br /> OTHER CLEANUP SITE(NON-.OP) 0 FOOD FACILITY )M SOLM WA57E VEHICLE <br /> UNDERGROUND TANK(MONMHUNGrREMOVAL) O DOG KENNEL lg DAIK <br /> 14 HAZARDOUS WASTE GENERATOR 13 cHicKEN RANCH IF PKG TREATMENT PLANT <br /> Qk TIERED PFRMrrrED FACutTY o MOTFIIHOTEL. -.. 10.PUMPER TRUCN7YARDIC14EM TOILETS. <br /> © TATTOOIBODY PEIRCING 0"POOLjtPA -' Its LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY IFL PUBLIC WATER SYSTEM G OTHER(PLEA5ESPECIFY 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 /> y the appropriate box(es). At least one'file type MUST be selected. Fax to_(2q9)464.t1J38,ar mail tv tttM <br /> address Indicated above. <br /> 2. EHD will notNy the applicant if any EHD files exist. An appointment For review will he confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application, The fifers <br /> will be held for a maximum of five business days for review. Appointments shoulci be scheduled <br /> s accordingly. <br /> 3. A file that Is actively being worked an by EHD staff may not be Immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any fie not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> f' of the applicant. Future file reviews by the sante applicant may require a$8700 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8, fI Applications received after 3:00 pm will be processed the next business duty. <br /> CONFIRMED APPOINTMENT DATE � TIME, <br /> DATE CONFIRMED PHONE FAX WnALS <br /> REVIEUHED YES NO R!%qF.W DATE <br />