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05/09/2003 14:48 9255517464 EN VIROFORENSICS PAGE 01/01 <br /> PATERECENED ItF'O LOG HUM <br /> r SAN JOAQUIN COUNTY 19Ky <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> r�� �' STOCKTON CA 95202 O <br /> (209)468-3420 <br /> OUBLIC RECORDS RELEASE APPLICA-rIOnI _ <br /> APPLICANT BUSINESSIAGENCY�aa�R.,-•-� - <br /> ADDRESS <br /> PHONE_C7,2S 551 - 72r2 y FACSIMILE S -`� <br /> TENTATIVE'APPOINTMENT DATE 6. TIME <br /> (Please give 7 to 10 business days from date of application submlttai) <br /> r <br /> CHECK BOX TO EXPEDRE REQUEST-$119.00 EGUE37 PROCESSED IN 3 BUSINESS DAkYS n <br /> SIGNATURE OF APPLICANTIU <br /> �AT'I= <br /> FILE ADDRESS THISS 31DEEMU S'i qFF USE ONLY <br /> PROGRAM IvLEM-NT:;SEARCH <br /> i <br /> �1JJ .S Ccsc��To�s, -- --• — . <br /> `fit d\Je� S-[c+... '--•— �-^';�� �..�. <br /> ENVIRONMENTAL HEALTH DIVISION FILETS <br /> VNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOL ID WAS'IEe FAC:IUTY <br /> "HER CLEANUP SITE(NON-LOP) ❑ FOOD F:RCILITY El SOLID'1VASlE'VEMICLE <br /> [UNDERGROUND TANK(MONITORINGrREMOVAL) ❑ DOG KENNEL EI DAIRY <br /> Ea HAZARDOUS WASTE GENERATOR O CHICKEN RANCH El PK(;THEATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY tl MOTEUHOTEL Cl PUMPE R TRUCKUYARD/CHEM TOILfiTS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA Cl.LARD USE A?PUcA,nON SITE.: <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE <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: Pax to 219 x}34-0138 or mail to the <br /> address indlc t d above. �` <br /> 2• EHD will notify the npplicant if any EHD files exist. An appointment for rElvi'ew will hO Confirmed <br /> approximately five business days but no later than ten(10)days after reo:eipt of applicatlon. The files <br /> will be held for a maximum of five business days for review. Appointme As should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Irt modiataly available for review. A now <br /> application may be submitted when the file is available. <br /> 4• Any file not returned in the same condition as released will be ireorganizod by E:10:stiff at the impense <br /> of the applicant. Future file reviews by the same applicant may require a $119.0() depot;It 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 (lay, <br /> CONFIRMED APPOINTMENT DATE -- --� � <br /> TIME _ <br /> DATE CONFIRMED PHONE FAX 1141TIALS <br /> REVIEWED YES NO REVIEW DATE <br />