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01-06-'03 14:24 FROM-LFR 1. -NE-FRICKE 7144440117 T-492 P01/01 U-721 <br /> ao�SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES CIIe oe MUMllf11 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ' 304 LAST WEBER AVENUE,THIRD) FLOOR 1109 . <br /> J��i (j L!103 STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 61 a ke 14uin zie DUSINESSIAGENCY LF- P , :ti, <br /> ADDRESS3150 9V'1',<40 ( 5+,ree� u I'�t �Sy Cos oT P4 C x i C14 9 7 6Z 6 <br /> PHONE 714« `.1 Lilt— O 1 1 1 G'j'L`I S FAUIMILE '7!y r 4 — O( J <br /> TENTATIVE`APPOINTMENT DATE E�+r Il'Gf I7o5f7rfil TIME <br /> (Please give T to 1`0 business days from date of opplleatlon submial) <br /> CHECK BOX TO EXPEDITE REQUEST-$09.00 FEE—REQUEST PRO ESSEO IN 3 BUSINESS DAUnt <br /> SIGNATURE OF APPLICANT . ', DATE <br /> FILEADDRESS THIS SIDE EHD STAFF USE ONLY <br /> t y- PROGRAM ELEMENTS SEARCH .r <br /> I 101 1 IY'r1 L. OV` A F CONN Qi4. Cy F+ /', r �1 C.t <br /> oNj,4rA <br /> f 5,00f�Ir ter+ (Loa F-v-t Gtr, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP 51TE(LOP) ❑ HOUSING ABATEMENT 0SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 0 VNDERGROUNO TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEL/HOTEL 0 PUMPER TRUCKrYARDrCHEM YOILETS ' <br /> 0 TATTOOfOODY PEIRCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL.WASTE FACILITY 5 ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses in the space above. Select the type(s)of files from the list above by chocking <br /> the appropriate box(es). At least one filo type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> s address indicated above. <br /> 2. EHD will notify the applicant if any EHD riles exist. An appointment for review will be confirmed <br /> approximately five busirtoss days but no later than ton (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 filo that Js actively boing worked on by EHD staff may not be Immodiatcly available for reviow. A now <br /> applicatlon'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 rile 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 /> CONFIRIUIEb APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE '"'f <br />