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SECOR PAGE 01/01 <br /> 07/28/2003 10:34 916860430 FIFTH FLOOD PAGE 02 <br /> q/1 L//'Ldb;I 15:15 20• —93433 <br /> JAI�.IiEGEIVi:D L-HV Luti 1{tJtdU>:]c <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SEaVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> I 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 0 <br /> }I,)I_ ? L003 (269)468420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> _ ri%,Ir:: -4n;Try : i�r. <br /> APPLI&ir,' 1, <br /> TIrINi BUSINESSIAGENCY <br /> ADDRESS D I V. L <br /> PHONE ug BIQL r��U r <br /> A <br /> TENTATIVE"APPOINTMENT DATE IME u a v. <br /> Tieaye give 7 Sa 10 Dual ss days h°m Sip of aPPiIOaGvn submitral] <br /> CW CK BOX TO EXPEDITE RE EST•387.00 PEE—RERU48T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNtATURE 4F APP41CAN7 ,, �„ •'a q Q A� .� DATE 0-7 <br /> I <br /> FILE ADDfiESS THIS SIDE O STAFF USE ONLY <br /> PROGRAM EL1"MKM WROK <br /> 314 r AAt (cam_ Trac CA qs,3 4, 5 <br /> X35 To�}e i'.o L � <br /> z <br /> l� <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FIDS <br /> ■ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT © 501-10 WASTE FACILITY <br /> N OTHER CLEANUP SrTlr(MON -'T —AV-04t- O FOOD FACILITY d SOLID WASTE VEHICLE <br /> n UNPERGROUNDTANKC MONITQRINGIREMOVALI e7 POG KENNEL b DAIRY <br /> ❑ CHICKEN RANCH 0 PKC TREATMENT PLIANT <br /> ❑ 'HAZARDOUS WASTE GENERATOR [I 1e1prSELlH4TEL Q PUMPERTRUCKIYASWCHEMI TOIL'E76 <br /> D TIEIYE[]PERMITTED FACILITY C3 LAND Use APPLICATION SITES <br /> 4 TATTOOISODY P1rIRCING D POOLJSPA G OTl3LR(PLEASE SPECIFY ABOVE} <br /> ❑ MEDICAL WASTE FACILITY CI PUBLIC WATER SYSTEM <br /> 1. List up to ten addresses in the space above. Select the types)Of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fox tq 209)464-0136 cr mail IR the <br /> addregs ladijgatedeve <br /> 2. EHD will notify the applicant if any EHO files exist. An appointment for review will be cQnfirnned <br /> approximately five business days but no later than ten(10)clays after receipt of application. The flies <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 avalll;mble for roview. A now. <br /> application may be subrn.itted when the file is avallable,. <br /> 4. Any file not returned in the salTle condition as released will be reorganized by EHD staff at the expense r <br /> of the applicant. Future file reviews by tho same applicant m-ay require a$87.00 deposlt prior to review. <br /> S. '`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 _ _,.,r._ - PHONE . FAX INITIALS l <br /> REVIEWED YE5 NO REVIEW DATE r <br /> err oo�+ aeror . <br /> ' l <br />