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06/17/2004 08:44 FAX 209 9480" Z002 <br /> _ EHO LOG NUMBER <br /> ����T RECE�l� <br /> o ,til`„I <br /> �„I i 1C'L� SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 17 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA'95202 <br /> ENVIRC�MENI HEALTH (209) 468-3420 <br /> 59 <br /> PEBN11TISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT S 11 1 Lk— BUSINESS/AGENCY <br /> ADDRESS Z (C—,LIE-- 7. 51 <br /> PHONE 1`b+l `•ts FACSIMILE -1 Li —06 �-I <br /> ZJ� <br /> TENTATIVE*APPOINTMENT DATE Z 411 0 L4 <br /> TIME submittal) ' <br /> (Please give 7 to 70 business days from date of application <br /> Q CHECK BOX TO EXPEDITE REQUEST-387.00 F —REQU T ROCESSED IN 3 BUSINEd <br /> SS DAYS / 4ll <br /> 6 /}( <br /> SIGNATURE OF APPLICANT I PATE cic � <br /> FILE ADDRESS THI5 SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Ll((7 WIA+I� <br /> CIA G ' <br /> q 1 <br /> Ili—f)O <br /> at � t'L E <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT H SOLID WASTE FACILITY <br /> IN UNDERGROUND TANK(UST)CLEANUP SCrE(LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> R OTHER CLEANUP SITE(NON LOP) p DOG KENNEL X1 DAIRY <br /> I' UNDERGROUND TANK,(MONITORINGIREMOYAL) CKEN RANCH 10 PKG TREATMENY PLANT <br /> 10 HA7ARDOUS WASTE GENERATOR l7 CHI[3 MOTELJItOTEL ❑ PUMPER TRUCKlYARD/CHEMTOILETS <br /> 0 TIERED PERM FACILITY 0—POOL/SPX ” ft LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING l56 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> la MEDICAL WASTE FACILITY <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. ax to 2 9 464 138 0 ail e <br /> tot <br /> address Indicated_ ba ove•, <br /> 2. EHD will notify the applicantIf any EHD files exist. An appointment for review will be confirmed. <br /> approximately five business days but no later than ten(10) days Ointments should er receipt Of application <br /> shed ledf les <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A ne% <br /> application may be submitted when the file is available. Staff at the eXpens, <br /> 4. Any file not returned in the same condition as releasedcant may taro ire a$87.00 deposit po f prior to evier <br /> of the applicant. Future file reviews by the same app Y q <br /> 5. *TENTATIVE appointment dates must be confirmed <br /> with EHD staff. <br /> next business day. <br /> 6. Applications received after 3:00 pm will be processed <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEW DATE <br /> �— <br /> REVIEWED YES NO <br />