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y' lun 25 02 08: 46a p- <br /> 06/25/2002 08:26 1138 ENVIRONMENTAL ALTH PAGE 01 <br /> SAN JOAQUIN COUNTYPUSQC HEALTH-SERVICES _ 00MANER <br /> ENVIRONMENTAL HEALTH DIVISION <br /> " 304 EAST WEBER AVENUE,THIRD FLOOk <br /> *fq STOCKTON CA 95242 <br /> (209)468-3420 <br /> y PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT !l�1 C�' OUSIMM5IAGENCY 2 <br /> ADDRESS L2SS Ue, �U 3 <br /> PHDNE )-S —(,0 2- L3 FACSIMILC q a_5 <br /> TENTATIVE'APPOINTMENT DATE l °a�h <br /> (Pt• co we 7 a to hu s TIME <br /> a+Yi - Delo pplk;SIISS <br /> submittal) <br /> CHECK BOX TO E)(PEDITE REgU � T� <br /> 589.00 E -REQUEST PitOC�St �BU UAYS <br /> SIGNATURE OF APPLICANT - uisiLtl DATE (0 1 o Z � a <br /> FILE ADDRESS TH15 SIDE EHb STAFF USC ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> L?—Lt;co /1 CA <br /> sel <br /> 470 La[� r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT 117 SOLID WASTE FACILITY !' <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY El SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(16IONITORINGIREMOVAL.) D DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR D CHICKEN RANCH 91 PKG TREATUENT PLANT��' <br /> a TIEREn PERMITTED FACILITY Q MOTELMDTEL 0 PUMPER TRt1CKlYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRMUG 0 POOLISPA 4 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY , ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY AROV6) , <br /> 1. List up to ten addresses In the space above. Select the type(a)of files from the list above by checking <br /> the appropriate box(es)_ At least one filo type MUST be selected. Fax to(209)464.6138 or mail to the �J <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 /> appileatlon may be submitted when the Tile is available. 1 <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicanL Future File reviews by the same applicant may require a$69.60 deposit prior to review, y <br /> 5. 'TENTATIVE appointment dates crust he confirmed with EHD staff. <br /> 6. Appli"tions received after 3:66 pm will be processed the noxt business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YFS NO REVIEW DATE <br />