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LHU LUL,NU&lbLH <br /> SAN JOAQUIN COUNTY <br /> EN._ ,ONMENTAL HEALTH DEPARTfI. _,T <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> JUN 1 1003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT < G I r 'J 4I 6-/�"BUSINESSIAGENCY L L kr /J._.rf L i, « 12 <br /> f <br /> ADDRESS z z IC '[ �1-'-'rZ e! <br /> PHONE 9 `r - 7, `� FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> ❑ I <br /> CHECK SOX TO EXPEDITE REQUEST-$B9 Q�FEE- QU PRdCES D IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ` / ti DATE �r <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> /� PROGRAM ELEMENTS SEARCH <br /> Ti(_7=f �� `!1 /✓�icnfCiC ftn�� Clot� : <br /> n Aimm itnr7 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 6 - f 6 -o-5 <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY CI SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑BUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA I2f LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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 held 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. Future file reviews by the same applicant may require a $89.00 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4802-006 — --' - <br /> 312612003 <br />