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03/11/2003 13:52 FAX 209 9480621 l000l ,001 <br /> DATE RECEIVED E110 LOG NUMBER <br /> SAN JOAUUIN COUNTYPUBLIC HEALTH SERviCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> MAR 1 1 2003 (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUC:ANTr' BUSINESSIA�G+ENCY <br /> ADDRESS ZED '7/ rLJyI/v� <br /> PHONE_;Di=ZR 2— 70 7z(J FACSIMILE T7Z, <br /> TENTATIVE" APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> r , • <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS l , n ' 31 <br /> SIGNATURE OF APPLICANTDATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> i uA y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Al SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Z SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCFfYARD/CHEM TOILETS <br /> 1:1 PEIRCING <br /> ❑ POOUSPA .1 . ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checkilig <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 20 46 E4)13$ or majL_t0_�h! <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 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 EHE)staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a $87.00 dl:posit 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 /> EM 00 14 OAMZM <br />