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d� Mar . 5 . 2002 5 :07PM DOR EARTH TECHNOLOGIES No • 8600 P . -4/4 <br /> 1S 11 � En <br /> - o L"NUM" �J <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> f ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 0211PIR, 5 Ff) IF; z (209)468-3420 <br /> t 3LIC RECORDS RELEASE APPLICATION <br /> APPLICANT—Q ,;L?Qi4tZ;4—($ Y g7�—BUSINES$/AGENCY <br /> ADDRESS <br /> PHONE I_ 1a FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE I1X/`� D"Z^ TIME <br /> Y-y (r'leasat��ess AC4,14 <br /> 4AYS <br /> CHECK BOX TO EXPEDITE REQUEST-$a .00 FEE-RE ST P 3 5 - <br /> SIGNATURE OF APPLICANT DATE S n-t 02 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> tI V <br /> 0 3527 <br /> (219 <br /> (4u s <br /> l 29Fo 95� JI�J <br /> MOV�32± SIV <br /> °I 3 <br /> t 27 3 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 1.7 SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑�oLID WASTE VEHICLE <br /> t�UNDERGROUND TANK(MONrrORING/REMOVAL) ❑ DOG KENNEL. M'DAIRY <br /> R-HAZARDOUS WASTE GENERATOR F-CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 12�'CIERED PERMITTED FACILITY ❑ MOTEL(HOTEL ❑ PUMPERTRUCKIYARD/CHEM TOILETS <br /> 0 TATTOOIBODYPEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> M-MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFYA§OVE) <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(ez). At least one file type MUST be selected. Fax to (209)484-0138 Qr 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 appilcatlon. The fifes <br /> will be hold 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 />