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09/17/2003 09:37 FAX 209 9480621 wtE Necaly� . r¢C LA3LL--1 -SEP 1 7 2003 APPLICANT ADDRESS SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (209) 468-3420 PUBLIC RECORDS RELEASE APPLICATION PHONE '2 x Cii 4 r0 Q N S BUSINESS/AGENCY �''t � r Ltt_ -(L M Z 004/004 Emu IAC NUMaEa 1496 TENTATIVE" APPOINTMENT DATE (�L �/ O z TIME ? (Please give 7 to 10 buslness days from date of appllaUon submittal) '' ■w■� {AI CHECK BOX TO EXPEDITE REQUEST - 587.00 F QUEST P CESSED IN 7 BUSINESS DAYS SIGNATURE OF APPLICANT DATE O W �j01? ENVIRONMENTAL HEALTH DIVISION FILES %l UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT W SOLID WASTE FACILITY fil OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY O SOUD WASTE VEttICLE tR UNDERGROUND TANK (MONITORING/REMOVALI ❑ DOG KENNEL 29 DAIRY Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ® PKG TREATMENT PUNT ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ _PUMPER TRUCK/YARDICHEM TOILETS 0 TATTOO/BOOYPEIRCING ❑ POOVSPA ""' 0 LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Cl OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail tot e address Indicated above. . 2. END will notify the applicant if any EHD tiles exist An appointment for review will be Confirmed, approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned In the same condition as released will be reorganlzed'by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3;00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED TIME PHONE FAX REVIEWED YES NO REVIEW DATE INITIALS ..•THIS SIDE EHD STAFF USE ONLY PROGRAM +1Ui.1 ST,LI11�L611! NUS O W �j01? ENVIRONMENTAL HEALTH DIVISION FILES %l UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT W SOLID WASTE FACILITY fil OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY O SOUD WASTE VEttICLE tR UNDERGROUND TANK (MONITORING/REMOVALI ❑ DOG KENNEL 29 DAIRY Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ® PKG TREATMENT PUNT ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ _PUMPER TRUCK/YARDICHEM TOILETS 0 TATTOO/BOOYPEIRCING ❑ POOVSPA ""' 0 LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Cl OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail tot e address Indicated above. . 2. END will notify the applicant if any EHD tiles exist An appointment for review will be Confirmed, approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned In the same condition as released will be reorganlzed'by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3;00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED TIME PHONE FAX REVIEWED YES NO REVIEW DATE INITIALS