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:I:* 10'39U8 _10001 ** �y��• tNV1KUNMtNIYL HtAI• PAGE 01 <br /> any nlKnNV • y` Lb.,•n .M1.u..O. <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION I ' <br /> E�1VED) 304 EAST WEBER AVENUE,THIRD FLOOR a <br /> STOCKTON CA 9$202 <br /> (209)468-3420 <br /> JAN 1 5 2003 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APp�I,G, F H Q BUSINESS/AGENCY_ ST- <br /> M_ <br /> T- tf�1 <br /> ADDRESS LI 0 id C lir klA. lr_ lA q4901 <br /> PHONE 51D" FACSIMILE' S►o" �3Y1'7(.o'7(a <br /> TENTATIVE`APPOINTMENT DATE DD 3 TIME mr n i'n ci <br /> y <br /> t+f (Pleaso pive7 Leis bWinezzdaysfrom data of application submlltal) '�/(/ <br /> u CHECK BOX TO EXPEDITE REQUEST.$89.00 FEE EQUEST PROCESSED IN 0 BUSINESS DAYS — " n t / <br /> -SIGNATURE OF APPLICANT �(�Q/lC(/v� DATE Ir' D3 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> N. MQn St. I MrAn+p(,,,Aus <br /> I o7I C. LUST <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOUD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) <br /> �yQ�(' O FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> yJ` UNDERGROUNDTANK(MONITORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> ❑ NAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH D PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ' ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOISODY PEIRCING ❑ POOLAPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY Cl PUBLIC WATER SYSTEM 0 .OTHER(PLEASE SPECIFY ABOVE) <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 /> address indicated above. <br /> 2. D will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> EH <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 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$89.00 deposit prior to review. <br /> S. "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 /> FCONFIRMED-APPOINTMENT DATE TIME, <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> e�+aor <br /> e�r«�.,• s. ad 80:ET 200E ST NUf <br /> T0iT0'd B£10b9460EL 01 <br />