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"--Gf723/2004 08:24 FAX 209 94800" �j002 <br /> .�. <br /> EHP LOC HUMBER <br /> OATf RLCEIV60 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 1r� ENVIRONMENTAL HEALTH DIVISION <br /> RECC11YL� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> FEB 2 3 2004 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT " /�/G� BllSINESSlAGENCY �lf r'f!!�e Idem <br /> ADDRESS Iy �i4 <br /> PHONE '`7 FACSIMILE <br /> 1 <br /> TIME <br /> TENTATIVE'APPOINTMENT DATE v <br /> (Please glue 7 t0 10 business days from date of applipUan submittal) �� I 2 314 , <br /> ::�SCHTECK BOX TO EXPEDITE REQUEST-3$7.00 FEE—R QUr:3 PROCESSED IN 3�ESLJSINESS05 <br /> URE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> MG CSa��c G✓ I r t�C r�l G ilvcr�r (✓f + T <br /> 5,6 q I v <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Za-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT OLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 F000 FACILnY LID WASTE VEHICLE <br /> UNL)ERGROUHD TANK(MONrrORINGIREMOVAL) 0 OG KENNEL IDAIRY <br /> OUS WASTE GETIERATOR @ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILrrY ❑ MOTELiHOTr=L ❑ PUMPER TRUCKIYAROlCHEM TOa-ET`' <br /> ❑ -rATTMEIODY PEIRCING ❑' .000SP4 - - LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY uBUC WATER SYSTEM ///U OTHER(PLEASE SPECIFYASOVE) <br /> "I. List up to ten addresses in the space above. Select the type(s) of,files from the list above by checkinc_ <br /> the appropriate box(es). At least one file type MUST be Selected. Fax to 209 464-0138 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 ne <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 F.HD staff at the expens <br /> of the applicant. Future file rovlews by the same applicant may require a$87.00 deposit prior to revie' <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 INMALS <br /> REVIEWED YES NO REVIEW DATE <br />