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TO 1700452841 <br /> Qs5-$1-2�02i ,e --Irl FRC; 1 EIW�U1 hJMaoK <br /> UVJ - <br /> w AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> fIG 0ENVIRONMENTAL HEALTH DIVISION .,--- <br /> 304 EAST WEBER AVENUE,THIRD FL <br /> \ � [F�j <br /> - <br /> �� STOCKTON CA 96202 *!' '•J' <br /> 209 488-3420 � �]4 <br /> { ) � �- MAY �DOQ <br /> PUB C RECORDS RELEASE APPL vvlr�uivr ,tl'l L HEALTH <br /> APPLICANT <br /> SUSN69VAGENCY VICES <br /> ADGRE5S ' ` <br /> PHONEAC31MLE L <br /> TENTATIVE`APPON'TMENT DATE ' TIME 2 <br /> (Pwww IN*7 to 1Q business days date of aP0CCion su� -HECK BOX TO EXPEDITE REQUEST-$ 00 FEE-REQUEST PR CESSE I 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT C ^ DATE <br /> FILE ADDRE55 SIDE EHD STAPIF USE ONLY <br /> PROGRAM ELEMENT 55 CH <br /> 35' Tjti D <br /> amt �a O <br /> 0�-S <br /> 117 <br /> ENVIRONMENTAL HEALTH DiVIS1OH FILES <br /> UNDERGROUND TXNK(UST)CLEANUP SITE(LOP) O HOU3INO ABATEMENT 0 SOLID WASTE FACIUTY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTL VEHICLE <br /> UNDERGROUND TANK(MONITORINGJRrXMOVAL) O DOG KENNEL 0 DAIRY <br /> KA7ARDOUS WASTE OENERATOR O CMCKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERHC POKMITTED FACIUTY a MOTELIHOTEL 0 PUMPER MUCKrYARDICH1M TOILETS <br /> !� TATTODBODY PEIRCING CI POOL/IPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM in OTHER(PLUASE SPECIFY ABOVE) <br /> i. List up to tan addresses'in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(as). At least one fila type BUST be selected. Fax to f2¢6)JIM-0138 or mail to tbg <br /> Ioddress Indlcatld above. <br /> 2. EHO will notify the applicant If any EHD files exist. An appointment for review will be Confirmed <br /> approximately live business days but no later than ten (10) days after rec4lpt 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 Elle that Is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may ba submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be renrgarnlxsd by EHD staff at the expense <br /> Of the applicant Future file reviews by the same applicant may regUire a $78,00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be Confirmed with EHD staff, <br /> 6. Applications received atter 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT BATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> iMOC7 <br /> TnTGa P-PI I <br />