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Nov 25 03 10: 45a r Chesney GGR 7598 p . l <br /> UA I L RLGLrvtU - I UIO(BOG NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> AiTlv ; 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> r11:iL'1;-i STOCKTON CA 95202 1 3 <br /> ,,10CI -T (209)468-a .464-0138 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT, 2/ D/V C�LGSN�_� BUSINESSlAGENGY Ch`�S C��I 7"iN <br /> ADDRESS <br /> PHONE FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of appllwtion submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 00 FEE— ST PROCESSED IN 3 BUSINESS DAYS ` <br /> SIGNATURE OF APPLICANT DATE �� Z 3 -03 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 23 3 D a 40o r e NA R A <br /> Inn <br /> ENVIRONMENTAL HEALTH DIVISION FILES 3 J" <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOU51NG AUAi EMENT Q SOUD WASTE FACILITY i I O OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 OLIDWASTEVEHICLE❑ UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL VAIRY <br /> C3 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTELRtOTEL O',PUMPER TRUCKIYARDJCHEM TOILE TS <br /> O TATTOO4300Y PEIRCING 17 POOUSPA 8LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM LI OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the Hst above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicatpd ahnvo <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 /> applicationmay be submitted when the file Is available. <br /> 4• Any file not returned in the same condition as released will be reorganized by EHU 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 /> FDAYF- <br /> NFIRMED APPOINTMENT DATE TIME <br /> CpNFIRMED PHONE FAX <br /> INITIALS <br />