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Uf/Z1/YUr14 14:0d 2Uy-. b MUlltSIU AIG I'A13L 111 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> jd C �1Vpr ENVIRONMENTAL HEALTH DIVISION <br /> U E D 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> JUL 21 2004 (200)468-3420 <br /> ��AA11 �rPCU/�B1tLIIC RECORDS RELEASE APPLICATION _ <br /> APPLICAI4�`vl ^-1 E 4k v1 BUSINCSSIA(GENCY <br /> ADDRESS l l( r t'10k An -Lt',V41 SU.f+ $ 10 � .. t�jrt' <br /> PHONE Z^ f ,A_ZZ,tt FAC IMILC_ ���r S}�i'•^'�-Zq)^ <br /> TENTATIVE-APPOINTMENTDATr—q Dq TIME IIV4 <br /> (Plaa.'a eiv0 7 to 10 bu.inasy days(ruin data of application nubntittal) <br /> © CHECK BOX TO,EXPI&TE REQUEST•$07.00 FE`[ REQU^ES,nTPROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �/�n. V�� ` DATE _ -�Z I <br /> FILE AODftE55 THIS SIDE BHD STAFF USE ONLY <br /> a PROGRAM ELEMENTS SEARCH <br /> W. SAuAttA I kko,'A LC. J-&T-- <br /> S. AkAtr Si.o tc -t <br /> OSillia0tt, Avt LK4.0A • 5a( 1 ,tE <br /> E ll•L W $ Or- .y 3 n1 f_ <br /> Z °tl >V YyNA s ra :1) ¢^r\ <br /> 444 /d oSY ulr_ Sl-, Le V,/,Q <br /> S Siva <br /> tt.t�- t 4b�a <br /> .A <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE tLOP) 0 HOUSING AOATEMENT d SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINWREMOVAE) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TFWATMENT PLANT <br /> ❑ TIERED PERMITT4D FACILITY Cl MOTELMOTEL O PUMPERTRUCKtYAROICHEM TOILETS <br /> ❑ TATTOOIBODY PBIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE!FACILITY 0 PUDLIC WATER SYSXEM ❑ OTHCR(PLEASE SPECIFY ADOVE) <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 apprdpriate box(cs). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD files oxist. 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 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />