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FROM NOR Environmental • PHONE NO. : 209 369 4228 • Dec. 23 2002 12:25PM P4 <br /> uw Suc auxaErt <br /> I . ,S,AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> j�NVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> DEC 2 3 2002 STOCKTON CA 95202 ` <br /> (209)468-3420 <br /> �''h()!�PU$LICI RECORDS RELEASE APPLICAMN <br /> 7— <br /> APPLICANT_ �1I'C_ 1'2/nZ J,1(F/•1 !! , I BUSINJnEISSIAGENCY ll �Y�+.f/./YJK <br /> ADDRESS 2\2 KdUS�n �-ri f W• (-JY /_j `Z�/'O <br /> PHONE- 205)367-�O( FACSIMILE Lzorr 30-1�ZZ4 <br /> / <br /> TENTATIVE'APPOINTMENT DATE 3�A- 60 2663 TIME <br /> (Please give 7 to 10 business days from date of spPllcatlon submittal) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$69.00 FEE-•RE ESS PROCESSED IN 3 BUSINESS DAYS 3, q <br /> SIGNATURE OF APPLICANT 45 �._ \j DATE / Z3 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Ln- /) k� <br /> 3 S. ogre G <br /> 3M00 <br /> e. L : <br /> Lrwl-. <br /> 1EL M, d <br /> n JQ im <br /> 77�97 <br /> .. I G7Z;ia,A'm <br /> 77 <br /> ENVIRONMENTAL HEALTH DIVISION FILESSDIVISION <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> Or OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ti( UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNET 0 DAIRY <br /> AS HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELMOTEL 0 PUMPER TRUCK/YARO1CHEM TOILET$ <br /> O TATTOOIHODY PEIRCING 0 POOUSPA 0 LAND USE APPLICATION SREs <br /> 0 MEDICAL WASTE FACILITY 0 PUDUC WATER SYSTEM W'OTHER(PLEASE SPECIFY A130VP <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 typo MUST be selected. Fax to (209)4640138 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 FFD 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 /> m my — <br />