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i 08/.17!2003 09:37 FAX 209-.94866g1 - (%w <br /> � I �~ 004/004 <br /> DATE RECMM - Erin LOG!ru>V M <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE.THIRD-FLOOR <br /> 5 E P 1 7 2003 r. STOCKTON CA 952DZ <br /> (209) 468-3420 i <br /> _NIVIRUNMENT HEAIT PUBLIC RECORDS RELEASE APPLICATION <br /> P6 <br /> APPUCANT_4-+1J 1 �ji P2tA-__SHUSIN1<53IAGENCY -f�rJ y <br /> ADDRESS I <br /> PHONE Zc C1 LIC0 Q14 FACSIMILE Z0 6 D 6 <br /> r <br /> TENTATIVE*APPOINTMENT DATE / 03 ,TtllaE Z o <br /> (Please give T to 10 buslnass days(row date of appllcatlan submittal) ; <br /> CHECK BOX TO EXPEDITE REQUEST-3$7F QUEST PFrESSED IN 3 BUSINESS DAYS f , <br /> i1 L 1 <br /> SIGNATURE OF APPLICANT i1 DATE _ %� /4'-') <br /> FILE ADDRESS THIS SIDE EHD STAFF USI~ONLY <br /> j� PROGRAM ELEMENTS SEARCH <br /> kL4 t7 Z f}0 LAL zn' I� <br /> T ,r Ll 3 <br /> Lfz If f - 1Ir Q <br /> I r <br /> ,r <br /> 6Ro?'4 <br /> 3302 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )&A UNDERGROUND TANK(UST)cLEANUP SITE(LOP) a HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> f• OTHER CLEANUP SrM(NO"OP) I E7 FOOD FACILITY j 0 SOUR WASTEVeHICLE <br /> I!R UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL. RW DAIRY <br /> HAZARDOUS WASTE GENERATOR Ll CHICKEN RANCH! ! ® PKG TMATME W PRINT <br /> 0 TIFJZV-D PERMITTED FACILITY ❑ MOTELIHOTEL. Q PUMPER TRUCKiYARDICHEM TOILETS j <br /> 13 TAT OOIHODY PEIRGING f C).P00LAPA Xt LAND USE APPLICATION SMS <br /> i Cl MEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEM i' Cl OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. EaX to 209 04-0'128 or mail to t e <br /> Address Indicated above. . <br /> F 2. EHD will notify the applicant if any EHD files exist. An appolntmi ent 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. 4pointments should be scheduled <br /> accordingly. 11 <br /> 3. A file that Is actively being worked on by EHD staff may not beiimmediately 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 beireorganized'by EHD staff at the expense <br /> Of the applicant, Future file reviews b the same a lica•nt ma"' require a$87A0.deposit prior to review. <br /> Y 9 A <br /> PP Y <br /> 5. 'TENTATIVE appointment elates must be confirmed with EHD staff. <br /> 6. Applications received after 3;00 pm will be processed the next business day. } <br /> 4 CONFIRMED APPOINTMENT QAC TIME <br /> I. DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> i <br />