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Jul-29-03 11 ;59 From-URS SACRA N V0 • T-513 P.02/02 F-573 <br /> .,. �...�«.«.. EMD LOG NUMSFR <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT SUSINI;SSIAGENCY <br /> ADDRESS 't�2►��,FLr <br /> PHONC° FACSIMILE ' <br /> TENTATIVE'APPOINTMENT DATE_ TIME <br /> (Please give 7 to 10 business gays from date of application submitul) <br /> Q Ct7ECK BOX TO EXPEDITE REQUEST- 9.00 FEE—REQUEST PROCESUP IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � PATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> f9UNDERGROUND TANK JUST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT E1 SOLID WASTE FACILITY <br /> Tl THER CLEANUP SITE(NON-LOP) C2 FOQD FACILITY M SOLID WA$TE vEHICLE <br /> ' NPERGROUND TANK(M(ONITORING/REMOVAy M DOG KENNEL I1 DAIRY <br /> HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH A PKG TREATMENT PLANT <br /> G TIERED PERMITTED FACILITY M MOTELIHOTEL Q PUMPER TRUCK/YARDICHEM TOILETS <br /> Q TATTOO/BODY PEIRCING Gl POOLISPA Q LAND USE APPLICATION SITES <br /> Q MEDICAI_WASTE FACILITY Q OTHER(PLEASE SPECIFY)------ <br /> 1- <br /> PECIFY)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(2091 464.0130 or mail to 1he <br /> #ddr&ss indicate o <br /> 2. END 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 EHO staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $59.00 deposit prior to review. <br /> S. ;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 PATE TIME <br /> PATI=CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ehD 4b-02006 <br /> W26d0a2 <br />