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jun 20 03 09: 19a Mel 7 ; sa Kim 818-3C.3-'•894 F'• 2 <br /> _ r_N6 LOG NDWOFR <br /> DAT RECEI IIC- II i <br /> �__;;� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL :1EALTH DEPARTMENT <br /> J U rj '2NN 304 E=AST WEBER AVENUE,THIRD FLOOR <br /> STOCKI'ON CA 95202 <br /> (209;)468-3420 <br /> i_1i\11RGNf��E.fd'; i icAi_f r I - <br /> PUBLIC RECORDS RELEASE APPLICAI_IONif <br /> 111BUSINESSiAGENCY <br /> APPLICANT <br /> ADDRESS, 1O�y , F� C <br /> PHONE <br /> �- FACSIMILE: <br /> C (/ <br /> TENTATIVE'APPOINTMENT DATE TIME V�J <br /> (Please give 7 to 10 bustness d iys from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE—REQU `'T PROC SSED IN 3 BUSINESS DA•f S W' <br /> SIGNATURE OF APPLICANT <br /> UATE -- <br /> THIS SIDE EH5 STV'FF UI E:ONLY <br /> FILES ADDRESS PROGRAM ELEMENTS SEARCH <br /> or <br /> ENVIRONMENTAL HEALTH DIVISION FILLS <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT n SOLID WAST I2 I ACii-ITY <br /> 13 FOOD FACILITY 11 SOLID WAS E VE(FII,::LE <br /> OTHER CLEANUP SITE(NON-LOP) RY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG h ENNEL Cl[7 Cl PKI,TI?EAT11ENT PL1�N1' <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ MOTE EN RANCH <br /> ❑ TIERED R+�RMITTED FACILITY ❑ MOTEIJHOTEL q PUtnP[:R TRI 1GKJ'rARDICHEM TOILETS <br /> ❑ TIERED PBODY TED FACTCING ❑ POOLISPA ❑ LAUD USE A:PL'r.A'r10N SrrES_-- <br /> ❑ MEDICAL WASTE FACILITY 0 OTHEII(PLEASE SPECIFY)-- <br /> 13 <br /> •--•----- <br /> 1. List up to ten addresses in the space above. Select the type(s)of files f-Orn tho list llo el bryachecking <br /> the appropriate box(es). At least one file type MUST be selected. Fax tuL 0�.. _-13--- <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD filer exist. An appointment for review trill Ei1e'confirmed e files <br /> approximately five business days but no later than ten 10 days after receipt of application. <br /> will be held for a maximum of five business days for review. Appointment::.shc,uld be scheduload <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A neer <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorgani::ed by FHD stiff zit the expense <br /> of the applicant. Future file reviews by the:>ame applicant may require a$89.01) depasit 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 INITI%LS <br /> REVIEWED YES NO REVIEW DATE <br /> -66 4111-16 <br /> ==2001 <br />