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08/22/03 08:40 FAX ,�- --�` U002 1 <br /> + <br /> es/96/208n 10:93 464012- F-NVTRONMENTAL HEALS PAGE 91 <br /> `�.. E"LOQ t4"ER <br /> DATE RECVVED I <br /> SAN JOAQUIN COUNTY 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEI3ER AVENUE.THIRD FLOOR <br /> /N l 3 STOCKTON CA 95232 t2drk)I��f r 613 <br /> (229)468,3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENGY .^_ tt ' <br /> PL'CANT � .(I.I,�'t.1'.l d-R r - <br /> AoDRES$ t\� n1 �. ^2 a <br /> l .Uj, <br /> PHONE, (Cj 5� + <br /> TENTATIVE*APPOINTMENT DATE � . � Zp TWE f D aAAIN <br /> (Pleas*give 7 to 10 bdsirms dayt from date of SPIDUCOMOn suWitMi) <br /> L_I CHECK BOX TO EXPEDITE REQUFSTI 593.00 FEE- EQUEST PROCL'3SEb IN 3 BUSINESS DAYS <br />,. <br /> `-SIGNATURE OF APPLICANT PATE <br /> THIS SIDE CHD STAFF USE ONLY <br /> FILE ADDRESS " PROGRAM ELEMENTS SEARCH <br /> 2 t S0 Sfod-, A 952-10 lvr <br /> zzZ2. Raim mD c L <br /> ENVIRONMEN-'AL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SfT (LOP) C3 G HOUSING ABAT'CMENT I3 soLin WASTE FACILnY <br /> 15I' OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY d SOLIDWA5TE VEHICLE <br /> IIS UNDERGROUND TANK(MONrmRiNGI zmovAL) d DOG KENNEL ❑ DAIRY <br /> le HAZARDAUS WASTE Ir tNERA70R ❑ CHICKEN RANCH 0 PKG TIREATMENT PLANT <br /> 0 TIERED PERMITTED FACILrTY CIMOTELTHOTEL CI PUMPER TRUCKIYARDICHEfl4 TOILETS <br /> CI TArrOOI80pY PEIRCING fa POOUSPA 4Fn ❑ LAND USE APPLICATION SITES <br /> 4 MEDICAL WASTE FACILITY ❑ OTHER(PL.EASIE SPE❑ <br /> p <br /> . 11 List up to ten addresses In the space abOVO, geleot the type() of files from the list above by checking <br /> the appropriate box(es). At least aria file type MUST be selected. Fax to(za9)464-0138 or mail ia_the <br /> address.indicated above. <br /> 2. EFtD will notify the appiloant If any EHD files exist. An appointment for review will be confirmed <br /> approximately Sive business days but no later than tan(90)days after reaelpt of WlicPtl0r' The files <br /> will be held for a maximum of five business days for review. Appdintmetits should be scheduled <br /> accordingly. u <br /> 3. A file that Is actively being worked an by EMD staff may not be irnmedlately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the carne condition as releaaed will be reorganized by EH13 staff at the expense <br /> of the appligant. Future file reviews by the same applicant may require a$33.40 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO staff• <br /> g, Applications received after 3:00 pm will be proaessad the next business day. <br /> A. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMU 44-024M <br /> p7nar�oa3 ._ <br /> I <br />