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Mar . 5 . 2002 5: 07PM DOR EARTH TECHNOLOGIES . No•8600 P • -4/4 <br /> I <br /> yEO EHO LOG NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICE <br /> f: ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 0211P11 R, -5 FP1 4. 0 (2 <br /> 09) 468-3420 <br /> �U>3LIC RECORDS RELEASE APPLICATION <br /> APPLICANT�Q,: �_�BUSINESS/AGENCY I crKb ' 4 aTIck-- .on I I e.5 <br /> ADDRESS V� ,_ ) ) <br /> PHONE ^� -� �1 FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE /2 Y I 02— TIME vry - <br /> (PI easef�/ire 77 to 10 business date ota lits n sub flag <br /> CHECK BOX TO EXPEDITE REgUE37,S87.�' 19PB S YS <br /> SIGNATURE OF APPLICANT DATE1UZ <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> l �3 cil.er .l <br /> 11 V <br /> IZ-19 Ce <br /> v 3Sz� <br /> rvu ' s <br /> 1 21 o 90 3W <br /> t <br /> � 3 <br /> 1273 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT o SOLID WASTE FACILITY <br /> C] OTHER CLEANUP 51'fE(NON-LOP) 0 FOOD FACILITY ❑ yU LID WASTE VEHICLE <br /> 11-UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL pi�pAIRY <br /> WHATARDOUS WASTE GENERATOR La-CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> M-TIERED PERMITTED FACILrIY O MOTEL/HOTEL 4 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING ❑ PODUSPA " - ❑ LAND USE APPLJCA71ON SITES <br /> M-MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <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. Fax to (209) 404-0138 Qrmail 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 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 FHD 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 ffie 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 />