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09/19/2002 16:03 2579-2225 MODESTO A a PAGE P <br /> y <br /> .. ... ..,.... � ��w.�.n....�,.. . � ft.. <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 00304 <br /> EAST WEBER AVENUE,THIRD FLOOR D , <br /> I STOCKTON CA 95202 J <br /> (200) 400-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION qp 1 9. 2002 <br /> APPLICANT � � /C/PF BUSINCSSIAGENCY ATe-- AS5eciATyiRONMENT HEELTH <br /> ADDRESS ///7)1 -579 <br /> 2_Lj& Aj-mAy,65t-yT6 B A%oAesy:! CA `}r✓�7 P�JlITI ER <br /> PHONE. CZ!„-(,1 -5/ / — FACSIMILE CWq-) 579 e xz'S <br /> TENTAT IVE'APPOINTMCNT DATE' o/462- TIME I40: 00 A.AK• <br /> (Please Dive 7 to 10 busm .s days fro etc of ayplatlon nub,niu4l) <br /> CHECK BOX TO.EXPEOfTE REQUEST- D-RE- UE t RO D IN 16uSINFSS DAYS <br /> SIGNATURE OF APPLICAI DATE <br /> , <br /> FILE ADDRESS THIS SIDE CHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 4 L th S-r — <br /> a U <br /> T t lu <br /> Mt i <br /> 1-11N 9fi=,69fflJ" 1,12 Wo "D <br /> LOA <br /> 0 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMCNT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORINGIREMOVAL) O DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTEL/HOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PHIRCING ❑ POOUSPA O LAND USE APPLICATION SITES <br /> D MEDICAL WASTE'FACILITY O PUBLIC 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. 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 hold for a maximum of five business 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 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. Futuro file reviews by the same applicant may require a $07.00 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 DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> kb ca i. 040JN0 v.. <br />