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/ 05/09/2002 15:11 2094E�'NIS AGE STOCKTON PAGE 01/01 <br /> LLA It:MrccweU k Q40 LOO NUMBER <br /> SAN IOAQUIN COUNTYPUB IC HEALTH zit.RV <br /> IRONMENTAL HE kLTH DIVISION <br /> EAST WEBER AVEN E,THIRD FLOOR ;`�y <br /> :4 a STOCKT X68 202 <br /> "4 (209) 20 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENC <br /> ADDRESS <br /> PHONE asWe 2—/j&110 FACSIMILE <br /> 1 r� mlit I" ' <br /> TENTATIVE*APPOINTMENT DATE Q / J E <br /> (Please give 7 0 1 b awf a d of appll tion submittal). <br /> CHECK BOX TO EXPEDITE REQUE .s?a.0o Fv5—RPQUEST PRO IN 3 SINESS DAYS _ J <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ApDRES <br /> dCrL r dY1 S.z7 AS <br /> p r 7�Ck7-D n <br /> ENVIRONMENTAL HEALTH DIVISION FILES- <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING AB TEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILr Y 17 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKFM 1W CH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTE C7 PUMPER TRUCKIYARDICHEM-TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOLlSPA ❑ LAND USI~APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY Cl PUBLIC WA R SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 9. List up to ten addresses In tlis space above.- Select the type(s) of files from the list above by checking <br /> the approprlate box(es). At least one file type MUST be selected. Fax to (2091464-001311 or mail to t e <br /> addr $s indicated above. <br /> 2. ENC]will notify the applicant if any EHD files exis . An appointment for review will be confirmed <br /> approximately five business days but no later tha i ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days or review. Appointments should be scheduled <br /> accordingly. <br /> f m <br /> 3. A file that is actively being worked on by EHD sta may not be imlrediately 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 EMD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5., *TENTATIVE appointment date$must be confirm d with EHD staff. <br /> 6. Applications reGeived after 3:00 pm will be proce sed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME 1 <br /> DATE CONFIRMED PHO14E FAX INITIALS � T <br /> 5 <br /> REVIEWED YES NO REVIEW DATE <br /> oo Sa ouusraa <br /> i <br /> r <br />