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U1-1.)-L000 11;ZiHI`I rttUr TO 1VOV42y4162 F'.02 <br /> EHD LOG NUMBER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICE � � �•-- IVE <br /> ENVIRONMENTAL HEALTH DIVISION i <br /> 304 EAST WF-BER AVENUE,THIRD FLOOR f r <br /> x STOCKTON CA 95202 "J JUN - 82000 <br /> (209) 468-3420 �;/;P' L H <br /> PUBLIC RECORDS RELEASE APPLICATIO�� Cn�lN E 1jAL rt�ALT <br /> j 'SEHVI <br /> /� I <br /> gPPLICAN7 �-"� � �I,�GC Gt BUSINESS/AGEN/C/Y �P-lri PGjdet- / 6 <br /> ADDRESS Z Z51 Wl ►'-H� 5� -�dn Cm . 7 Z�S <br /> PHONE Z , FACSIMILE ► o a . ©(,o Zn.-oo t-C/ //�� <br /> TENTATIVE"APPOINTMENT DATE <br /> &7- 3-- ©O TIME 1O �- <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 800FEE-REO STP CESSED IN 3 BUSINESS DAYS <br /> DATE �' O <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> is ,- <br /> o + . II r t rl <br /> Z k <br /> 5 D SSV%r- <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES r ) <br /> -/ O HOUSING ABATEMENT 9I-`SOLID WASTE <br /> ✓FACILITY <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> f1� THER CLEANUP SITE(NON-LOP) O DOG KENNEL L7 DAIRY <br /> [➢'UNpERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> C�9'HAZARDOUS WASTE GENERATOR ❑ PUMPER TRUCK/YAROICHEM TOILETS <br /> al-I ❑ MOTEUHOTEL TIERED PERMITTED FACILITY - d OOELJH ❑ LAND USE APPLICATION SITES <br /> O TATTOO/BODY PEIRCING ❑ OTHER PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY PUBLIC WATER SYSTEM <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) 464-0138 or mail to the <br /> addre s 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 END staff may not be immediately 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 be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a 578.00 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 /> `Eh1 00 14 0i/QS/00 <br /> TOTAL P.02 <br />