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Oct 11-4 03 05:42p P. 1 <br />SAN JOAQUIN COUNTY h"U LUG NUMULA <br />OCT 1x'2003 ENVIRONMENTAL HEALTH DEPARTMENT <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />} i1IT,SEP.';;I;,E j (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT ,C. (ti BUSINESSIAGENCY_� � <br />ADDRESS / �cl w r 1 <br />PHONE ( ��) S�q — 3 FACSIMILE_ <br />TENTATIVE' APPOINTMENT DATE TIME <br />(Phase glue 7 to 10 bucinecs days kem date of appllullon submlltal) <br />CHECK BOX TO EXPEDITE REQUEST -S".00 FEE -REQUEST PROCESSED IN 3 BUSINESS D <br />AYS <br />SIGNATURE OF APPLICANT DATE <br />FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br />L PROGRAM ELEMENTS SEARCH <br />["Q <br />N" ((o� - Asn- �! <br />ENVIRONMENTAL HEALTH DIVISION FILES �n (� /.�1 �-?,I . G <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) t] HOUSING ABATEMENT ❑ SOLID WA5TE FACILITY <br />Yy-OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILnY 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MON ITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO(BODY PEIRCING O POOU3PA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(S) of fifes from tho list above by checking <br />the appropriate box(es)- At least one file type MUST be selected. x to (209) 464-0138 or mail to the <br />a red bove. <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 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 $89.00 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 />EMU 411.02.006 <br />712Gtl002 r J / �) <br />C <br />j7 <br />