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12/06/2002 10:55 FAX 209 9480621 1002 <br /> DATE RECEIVED .rf �� EMD LOU NUMBER <br /> N JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> DEC 0 6 2002 STOCKTON CA 95202 <br /> (209)468-3420 <br /> ENVIRONMENT HEAPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT���'/P /s2arY,�.c BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE FACSIMILEJ <br /> TENTATIVE'APPOINTMENT DATE /� /A:2, a� TIME ��' IRy'�� �u�S� <br /> (Please give I to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 87.00 EEE-REQUEST PROCESSED IN 3 BUSINESS DAYS (An `� <br /> 5 _ <br /> SIGNATURE OF APPLICANT DATE <br /> t <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> •��50� 5. N, �w4 9'f Q= a., cam- 36< - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT OLID WASTE FACILITY <br /> OTHER CLEANUP 817TE(NON-LOP) I7 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH p PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUC:K(yARD/CHEM TOILETS <br /> 0 TATTOOIBODY PEIRCING 13 FdOL1SPA ` ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUSLJC 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. Fa to 209 464-0138 or ail to the <br /> address indicateil 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$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO 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 />