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05/09/2003 14:48 9255517464 - ENVIROFORENSICS PAGE 01/01 <br /> DAIS RECIRVto <br /> SAN JOAQUIN COUNTY f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> �p\Y O.9 till).( STOCKTON CA 95202 <br /> (209)468-3420 J <br /> IL`IPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT- ..A� BUSINESS/AGENCY <br /> ADORES,9— .22AQa <br /> PHONE (9.2 851 - r127 y FACSIMILE(925) 55f <br /> TENTATIVE'APPOINTMENT DATE �L�( /S'1i1 TIME <br /> (Please give?to 10 business Kty¢imm date of application submittal) � � n L <br /> ST-$aS.DD EOU <br /> CHECK BOX TO EXPEDITE REQUEEST PROCESSED IN 3 BUSINESS DAYS 1 /l> , ' T <br /> SIGNATURE OF APPLICANT _ UATI:�_� <br /> FILE ADDRESS THIN SIDIi 711D 3'I AFF VSE OlILY <br /> PROGRAM I:LEMIHNTS STARCH <br /> — <br /> J ENVIRONMENTAL HEALTH DIVISION FILETS <br /> m1LIACNDERGROUND TANK(UST)CLEANUP SITE ❑ HOUSING ABATEMENT CI SOLID NASI E FACRIIY <br /> �THER CLEANUP SITE(NON-LOP) ❑ FOOD FILITY ❑ SOLID'NAS-I E VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL CI DAI;:Y <br /> 0 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH Cl PKC:THEATI:IENT PIANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL CI POMPE R TRUCKIYARDICHEIM TOILETS <br /> ❑ TATTOOIBDDY PEIRCING ❑ POOL/SPA Cl LAA D USE AIPLICA:nON S(TE9 <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)__.___ <br /> 1. <br /> PECIFY) - <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_L209Li4-0138 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. Tile files <br /> will be held for a maximum of five businoss days for review. Appohitme its 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 reorganimid by EAD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $119.011 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 business day. <br /> 41 Ift <br /> CONFIRMED APPOINTMENT DATE TIME hiLNPH <br /> DATE CONFIRMED PHONE FAX If11TIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> v+anoo� <br />