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09/17/2000 09:07 FAX 209 948062] Z003/004 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ENa LOG NUMBER <br /> SEP 1' 7 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 1L-:NVIR0I*P,E 1, HEAL(H STOCKTON CA 95202 <br /> qq5 <br /> (209)468-3420 <br /> P .Ri�.lIT/SE2'ICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY <br /> ADDRESS M-12:: I -� �)-c C7 <br /> PHONE c-t��f7C q� 2 /FFACSIMILE 7L�U�-'� yT)�O 6>-z' — <br /> TENTATIVE"APPOINTMENT DATE . % /��' /'9 } TIME if 2 CTCV <br /> (Please glue T to 10 buhIness days from date o(appllcation submittal) r <br /> CHECK BOX TO EXPEDITE REQUEST-S87.00 FEE— QUEST PROCESS 3 BUSINESS DAYS 1 <br /> �\ <br /> SIGNATURE OF APPLICANT -- DATE <br /> 1� <br /> FILE A 3DRF_33 THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS„SEARCH^T' e <br /> Ctl L. 5�c K 1�r•�, t It �_ L1 U <br /> lhC Hw 49 <br /> W S 4 6 L a,s wf. <br /> Li <br /> 0SS L t i <br /> F ILLS L , � <br /> ENVIRONMENTAL HEALTH DIVISION FILES��•,/ l t ! <br /> 1�L UNDERGROUND TANK(UST)CLEANUP SPIE(LOP) ❑ HOUSING ABATEMENT I; SOLID WASTE FACILITY <br /> (P OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> (�t UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑ DOG KENNEL JI DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH E3 PKG TREATMENT PLANT <br /> C) TIERED PERMITTED FACIL17Y ❑ MOTELlHOTEL ❑ PUMPER TRUGWARD/CHEMTOILETS <br /> ❑ TATTOOI80DY PEIRC.ING ❑'POOL/SPA - -" M( LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ PUBuc WATER SYSTEM ❑ 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. <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.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 an 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$87.00 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 buslness day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RZVIEWED YES NO REVIEW DATE <br />