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03/11/2003 13:52 FAX 209 9480621 <br />DATE RECEIVED <br />SAN JOAwUIN COUNTYPUBLIC HEALTH SER. ACES <br />ENVIRONMENTAL HEALTH DIVISION <br />���J II, 304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />MAR 1 1 2003 (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMDER <br />APPLICANTr�� �G iP Ygf)Ll.4lln BUSINESSIAGENCY ZZ -- <br />11 q <br />ADDRESS ��' <br />PHONE W- Z2- 2- Seo -3zO FACSIMILE <br />TENTATIVE` APPOINTMENT DATE 71ME <br />(Please give 7 to 10 business days from date of application submittal) <br />3 <br />13 CHECK BOX TO EXPEDITE REQUEST - $87.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS �' I <br />SIGNATURE OF APPLICANT�.��i1 �ftrt DATE <br />FILE ADDRESS - THIS SIDE EI -ID STAFFIRSE ONLY <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />❑ FOOD FACILITY <br />SOLID WASTE FACILITY <br />SOLID ►HASTE VEHICLEUNDERGROUND <br />TANK (MONITORINGIREMOVAL) <br />j HAZARDOUS WASTE GENERATOR <br />/❑ TIERED PERMITTED FACILITY <br />O TATTOO/BODY PEIRCING <br />❑ MEDICAL WASTE FACILITY <br />❑ DOG KENNEL <br />❑ CHICKEN RANCH <br />❑ MOTELIHOTEL <br />❑ POOL/.SPA <br />❑ PUBLIC WATER SYSTEM <br />- DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ PUMPER TRUCK/YARDICHEM TOILIET,; <br />❑ LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />❑ FOOD FACILITY <br />SOLID WASTE FACILITY <br />SOLID ►HASTE VEHICLEUNDERGROUND <br />TANK (MONITORINGIREMOVAL) <br />j HAZARDOUS WASTE GENERATOR <br />/❑ TIERED PERMITTED FACILITY <br />O TATTOO/BODY PEIRCING <br />❑ MEDICAL WASTE FACILITY <br />❑ DOG KENNEL <br />❑ CHICKEN RANCH <br />❑ MOTELIHOTEL <br />❑ POOL/.SPA <br />❑ PUBLIC WATER SYSTEM <br />- DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ PUMPER TRUCK/YARDICHEM TOILIET,; <br />❑ LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses In the space above. Select the type(s) of files froi-n the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. F xto 20 46iL.-0138 or mall to ft_ <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 fillis <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 avail,11319 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 EHE) :staff at the expenso <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 INITIAI_:3 - <br />REVIEWED YES NO REVIEW DATE a !� <br />