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Jan 30 03 10: 39a AD. ^nvironmental Group 916- 9-6688 f'- 1 <br /> . ��'a-tib-G►a�l�JJ==art•t rttl�✓ IU lylboziut h'.�.il <br /> AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> `I`' lC-, ?/_S ` ENVIRONriAENTAL HEALTH DIVISION <br /> 304 EAST,WE13ER AVENUE,THIRD FLOOR <br /> JAN :3 0 2,003 STOCKTON CA 95202 <br /> (209)468-3420 <br /> R11VjR0N1V]!-JI 'i i-lr,-1LTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT A � BUSINESSIAGENCY QY1'� EUViVdNbl1ellhil <br /> ADDRESS 1425. i�l�eh ?4k (}IIL� -t#2U1 <br /> PHONE. Rt 6 C?21-0 6 60 FACSIMILE alb 6¢r 16 d't <br /> ENVIRONPJIEN 'r t��LiN <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (plca:e})ive7 to 10 bu_sincaa Mays from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUESa-$DT.00 FEE-RE-QUEST PROCESSED IN 3 BUSINESS DAYS ■ r> <br /> • <br /> SIGNATURE OF APPLICANT Uc_ ��� DATE I"'I�3 <br /> S} (C 1/3o/�3 <br /> FILE ADDRESS THIS SIDE EHD STAFF.USE ONLY I <br /> PROGRAM E-LEMENTS'SEARCH [ <br /> t 28 M. lie ��yt o s----�- § <br /> I 353S C(ICNKee P4ad <br /> -`— _ <br /> 34-00 d4rro a <br /> ell3008 E7I►' 4Ickt <br /> 7 4 12!� 00 7 <br /> I <br /> f � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Ed UNDERGROUND TANK(,UST)CLEANUP SITE(LOP). ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> faa OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY Q SOLID WASTE VEHICLE <br /> d Ut*RGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL I O.DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG•TREATMENT PLANT <br /> ❑ TIERED PERMITTEO FACIPTY ❑ MOTeLIHOTEL O PUMPERYRVGKr(ARD/CHEM TOILETS <br /> O TA7 i OOIBODY PE1RGtNG O POOUSPA• 0 LAND USE APPLICATION SITES <br /> O 'MEDICAL whsTE FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses:in the space above. Select the type(s) of fllds from the list above by checking <br /> the appropriate box(es).:At(cast one file type MUST be selected. Fax to(209)464-0138 or mail to iht: <br /> addresls indicated above. - <br /> 2. EMD will notify the appficant if'any EKD fries exist. An appointment for review will be confirtTied <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 busihoss,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 immedlat¢ty 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 roicased will be reorganized by EHD staff at the experisa , <br /> Of the applicant.I Future file reviews by the Same applicant may require a 587.00 deposit prior to review, <br /> 5. <br /> *TENTATIVE appointment dates must be confirmed with END staff. <br /> Applicalpris received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE';CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE i <br /> K w ui•oorouoo , . ' <br /> TOTAL P.01 <br />