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2 ; 3 ��2S Environmental Svcs. 408 '- 59-1224 P. 1 <br /> ecciv d e 0 _49am from CCITT GO 4 P15AS Env�onmental page 1 <br /> 0 AM FnOhl TO 14295350'K34 P.01 <br /> w+.� I:u1V LML4IrLl: <br /> SAN JOAQUIN COUNTYPUBL IC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH E]IVISION <br /> ^ ! ',Ii(:'_ 304 EAST WEI3CR AVENUE,THIRD FLOOR 7 <br /> STOCKTON CA 93202 <br /> 02 MAR -7 AM 9: (209)468.3420 <br /> 08BL.IC RECORDS RELEASE APPLICATION <br /> APPLICANT_�— IeL`V1l�r� BUS1NP39JA0CNCYPIF gZ, _ 9nVl*Acz 1.­ir_,1 jG. <br /> 1 <br /> ADDRESS` �J�c, `S. of p Ci �Z g <br /> PHONE <br /> TENTATivF--APPOINTMENT DATE P_ <br /> (Ptcrao gAo 7 01C uctate��plicati ubmlttal) <br /> L__l CHOCK 13OX TO EXPEDiTG REQUEST", AUTE-ZiT ESSE�iNr�BUSIN 3 DAYS <br /> SIGNATURE OF APPLICANT _ / , /r` 1]A1'>~ <br /> FILE A4DRES3 TH73 51DE F_ 10 STAFF USE gNLY <br /> PROGRAM CLEMENTS SEARCH <br /> � o W. t ltti � . ra .2 53 rvla <br /> W. <br /> i ITr5.2 tv <br /> Soo <br /> W. 4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLr-ANUP SITE(LOP) d HOUSING ABATEMENT In SOLID WASTE FA=1 Y c <br /> '9 OTHER CLEANUP SITE(NON-W) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE S <br /> n�-UNOEROROUNO TANK(MoNITORINGIREMOVAL) (3 000 KENNEL '0 DAIRY <br /> HA7AR6oU9 WASTC gEN[RATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT C <br /> ❑ TIERED PFRMITCEO FACILITY 0 MOTELJHOTEL O PUMPER TRUCKJYARD/CHEM TCtLET3 <br /> 4 TATT00Ja00Y PEIRCING ❑ POOLi5PA A LAND USE APPLICATION SITES <br /> 0 WDICAL WASTC r•ACILIT( 0 PUBLIC WATER 8Y3T1!M C OTHER(PLEASE SPECIFY ABOVE) <br /> I List up to ten sddre:,$os in the space above. Select the types) of files from the Ilst above by decoking <br /> the npproprlato box(as). At least one file type MUST be selected, Fax t4(2¢9)4LAJ38 or rn;i1 tp the <br /> addresp rn�llca;e�,r��ove. <br /> 2. EHD Will notify the applicant if any EHD files eXist. An appointment for review will be confirmed <br /> approximately five bu3ines5 days but no later than ten(10)days after receipt of application. The files <br /> will be held for x maximurr,of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 31 A ilio that is actively boing worked on by EHO stair may nvt be immediately avallable for rCview. A new <br /> application may be submitted when the filo Is available. <br /> d. Any filo not returnad in the same condition ns rclua!ied will by roorganJrod by EHO staff at the oxpense <br /> of the applicant. Futuro file reviews by tho same appil"lit may raquire a 587.00 depovlt prior to ravlow. <br /> 6- 'TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 6. Applications recelved after 3;00 pm will be processed the noxt business day. <br /> CONFIRMED APPOINTMENT DAT E TIME <br /> 1 - , <br /> i <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> Ri~VlES(YEO YES NO REVIEW OATS + <br /> AH CQ la uuG7N <br /> TOTPL h'.131 <br />