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Jut 07 03 02: 37p C I A 1 209'45- : 503 p. 2 <br /> 07/07/2003 03 13:55 464 ENVIRONMENTAL HEA-1 N411,l 0 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL_HEALTH DEPARTMENT <br /> J 304 EAST WESER AVENUE,THIRD FLOOR <br /> 2�)O <br /> STOCKTON CA 95202 <br /> (419)468.34120 <br /> I JPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> BUSINESS/AGENCY <br /> _ 'A- <br /> ADDRESS 3. r/�^,�4 <br /> QV I <br /> PHONE C-N / ` _ c FACSIMG.E / <br /> TENTATIVE'APPOINTMENT DATE ' I I J'. TIME <br /> (Please give 77o 10 business days from date of application aubmiNal) y I <br /> f ,tel l_ <br /> CHECK BOX TO EXPEDITE REQUEST 89.00 FEE-R QU i117, <br /> SSED IN 311USINESS DhYS / // <br /> SIGNATURE OF APPLICANT LAG % 2^d p DATI: �� <br /> FILE ADDRESS r� THIS SEl4D 31",+F USI: ONLY <br /> PROGR414 FLEME`NTS SEARCH <br /> II t <br /> IV <br /> --- - - ----- -----_j <br /> iL <br /> �9�1 <br /> ENVIRONMENTAL HEALTH DIVISION FILLS <br /> OEROROUND TANK(UST)CLEANUPSITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID;WA$T i FACILhTY <br /> ER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY 11 SOLO wAST,i VEHICLELDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL 1:] DAr?,Y "J <br /> K� HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 0 PKC;TEEATh'ENT PLANT <br /> 0 TIERED PERMITTED FACILITY O MOTEIJHOTEL U PUMPER TRVC'KPfA1k0/CHEM TOILETS <br /> 0 TATTOOISODY PEIRCING 0 POOLJ SPA L7 LAND LISE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY d OTHEJ (PLEASE SPECIFY) <br /> 1. List up to tan 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. Fqx to_LQ? ._^{-001313 or m i to jhe <br /> addr®ss Indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for rovbew M qi be confirmed, <br /> Approximately five business days but no later than ten(10)days after re(:ei It of'Ippnication. The tilos <br /> will be held for a Imaxlmum of five business days for review. Appolntme,its she Alt be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EMD staff may not be immediately av;ll4ablr for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition;,s released will be reorganlxi:d by E14101 rtaff at the expense <br /> of the applicant. Future file reviews by the:Iamb applicant may require I,$119.00 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 I'HONE FAX 11-11TOLS <br /> REVIEWED YES NO REVIEW DATE <br /> Im+.az <br /> �:.noos <br />