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09/17/2003 09:36 FAX 209 9480621 Z002/004 <br /> DATE RECEIVED enn LOG NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> F-1)L= __.l. ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR (( � <br /> SEP 7 2003 STOCKTON CA 95202 <br /> (209) 468,3420 <br /> NIQi1�1MENT HFALTHPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT V I \j t 1�"PC,CL-S BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE 209 ! 7�-(fl�. 17�iS FACSIMILE 9 �i�t���6ZI <br /> TENTATIVE'APPOINTMENT DATE q /T9- �0 3 TIME I Zio <br /> (Please give T to 10 buslness days from date of application subm ttal) J} <br /> CHECK BOX TO EXPEDITE REQUEST-4 T.00 F —REQUEST PROCESSED IN 3 BUSINESS DAYS JAI O <br /> SIGNATURE OF APPLICANT DATE <br /> (� <br /> FILE ADDRESS THIS SIDE EMD STAFF USE ONLY I <br /> PROGRAM ELEMENTS SEARCH <br /> 3A L, -,6 A 3 5 <br /> C Ii I, <br /> to 5(0 ` I. <br /> ENVIRONMENTAL HEALTH DIVISION FILES �t 1,�j (/t,{J� <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) i t HOUSING ABATEMENT I;k SOLID WASTE FACILITY <br /> I? OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL IN DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IR PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKrYARDICHEM TOILETS <br /> 0 TATTOOfeODY PEIRCING ❑-PdoLiSPA fa 'LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FAciLrrY ❑ PUBLIC WATER SYSTEM ❑ 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 mall to the <br /> address 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 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 $67.00 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 INITL4LS <br /> REVIEWED YES NO REVIEW DATE . <br />