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-JUL-11-03 FRI 01 :59 PM SAIC - SACRAMENTO FAX NO. 916 974 8830 P. 02 <br /> t!DATE RECENW - ��I (I !I `� EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> )l!L I. _� 2003 ENVIRONMENTAL HEALTH DEPARTMENT O <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ;t_i1LTH (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT OAO —� BUSINESS/AGENCY <br /> ADDRESS /�1��-�+� <br /> PHONE(�/G) g�- , / FACSIMILE Cj`/(o� 7/7-'_ad.� <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) ) f <br /> '=' CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS LWI <br /> SIGNATURE OF APPLICANT DATE <br /> DI Q THIS SIDE EHD STAFF USE ONLY <br /> IJ PROGRAM ELEMENTS SEARCH <br /> a8� <br /> Nr F1 <br /> H <br /> - D <br /> e2 <br /> a �o <br /> 3 <br /> Et11[IRO NTAL HEALTH DIVISI2 476 <br /> ONFILES <br /> ❑ SITE TANK(UST)CLEANUP SIITT (LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 0 OTHER CI.FANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> C3 TATTOOIBODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <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. Fax to(209)464-0938 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 now <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 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 /> wiv 4"Z-906 <br /> 317ff3003 <br />