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01/07/2002 16:07 2094673' AGE S1UCK101.a <br /> //// EFIo 1_0G NUMBER <br /> ATE RECEIVED `" <br /> SAN JOAQUIN GOUNTYPUDI-1C HEALTH SLICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> c) 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> '� <br /> ESSIAGENCY o <br /> ADDRESS / <br /> PHONE v FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME r /'rJ.rS <br /> (please give 7 to 10 business days fr m date of application submittal) <br /> 1 CHECK BOX TO EXPEDITE REQU ST-$78.00 FEE—REQUE T ROCES ED IN 3 BUSINESS DAYS <br /> DATE <br /> _2jy�-_� <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> +-L CISS T;_ <br /> C_ IAO- it <br /> S 35- <br /> I, 3S <br /> ENVIRONMENTAL WEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH n PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C3 MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> d POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICATATTOOL <br /> WASlODY E FACILITY' <br /> ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM <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 208 464-0138 or Mail 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 flie 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 $78.00 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 APPoiwrmENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> En 013 U 0110WUU <br />