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u2/04/UY NUIv 16:58 Fell 2U9 00521 KLEINFEL.DER <br /> DATE RECEIVED SAN <br /> LOG NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> f� ENVIRONMENTAL HEALTH DIVISION �/3 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> IL7'� I.1, ,,. , ,.,;. r Hf.)f i STOCKTON CA 95202 <br /> (209)468-3420 <br /> -2 EEB 5 am n?UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT f •(• C^' ��`�Q U��-�" BUSINESSIAGENCY <br /> ADDRESS �� E M �flc SfoGc 4"". <br /> PHONE 9y — 13 L(s FACSIMILE 'q2 —0 �t <br /> TENTATIVE'APPOINTMENT DATE / �— TIME <br /> (Plea��see tva 7 t7 to 10 business days from d e of application submittal) <br /> ID CHECK BOXTO EXPEDITE REQUEST-t87.00 FE�QU �CR1&IN*SINESS DAYS <br /> SIGNATURE OF APPLICANT �" � s' DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ( Min vt Sic lcJoa GA 4 a� .2 •SD <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �•UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 171 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br /> ❑ PKGTREATMENT PLANT <br /> je TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ..., ❑ UMPER TRUCK/YARDICHEM TOILETS <br /> ClTATTOOIBODY PEIRCING ClPOOLISPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 464-0 38 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$87,00 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 /> WIN 14 0"TM0 <br />