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03/30/2001 17:21 2 19-57 S 25 HODESTO ATC; RAGE bl <br /> 0.3-01-2P0O 05;4SAt^ FRa^",!••� TO 5792225 l°.02 <br /> uAecn <br /> SAN JOAQUIN COUNTYPUDLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR H 15 <br /> STOCKTON CA 05202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTDIrL„�r VGY� M�_ RUSWLu3iAGLNCY A-r <br /> ADDRESS �I� !✓�tixf� 16a1W I3' .Mg (�4 <br /> phlC)Nt Zd l 57+9t- ZZ.Z.lFACSIMILE ZO� S 2 22.rj <br /> TENTATIVE*APPOIYTIAVNT DATE!��Sol- _ - - _ TIME <br /> (P1n3st giVa 7 to 10 buSinC73 days from datq of appil6ation sUbmlttal) <br /> CItECK BOX TO FXPEDITE REQUIS r-$70.00 FF-E-ftEQUJi STPROCESSED IN 3 BUSINESS DAYS <br /> Gsr <br /> WNATURE OF APPLICANT AQ <br /> -_ D��`� �ou� A , _ _-_ DATE <br /> i <br /> VILE ADDRESS <br /> k 1 t! S vJ d S <br /> ald <br /> 5 3� W rtn� o-d Sl.oc S� <br /> ENVIRONMENTAL. HEALTH DIVISION FILES <br /> y UNDERORMND TANK(UST)CLEANUP SI7L-(LCP) G HOUSING ASATEMEN'r ❑ SOLIO WASTE FAC11,I7Y <br /> ❑ 01HER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON1T0rtIN(;1 iEMOVAL) CJ DOG KENNF-L ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH G PKG TREATMENT PLANT <br /> 0 TIERED PeRrarrTEO FACILITY O MOTPUHOTEL D PUMPIER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBOOY PEIRCiNG ❑ Pp0113PA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVF~) <br /> 1. List up to tan addresses In the Spate above. Select the type(Z) of tiles from the list above by checking <br /> the appropri*te boxes). At least one file tyke MUST be selected. Fax t4(201 4G4-413$Rnmall lQt4 <br /> 2. EHD will notify the applicant if any F-HD files exist. An appointment for reviaw will be confirmed <br /> approximately fivo business days but no later then ten (1 D)days after receipt of application. Tht files <br /> will be held far a maximum of five business days for review. Appointments should be schoduied <br /> actvrdingly. <br /> 3. A file that is actively being worXld on by EHA 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 END staff at the expense <br /> of the applicant. Fvture file reviews by the $ame applicant may require a $7$.00 deposit prior to review.- � <br /> 5. 'TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> t <br /> I <br /> CONFIRMED APPOINTMENT DATE w. TIME <br /> IDATF CONFIRMED Pl OHF, FAX INITIAL$ <br /> LtEVIEWF-D YES _ NO REIAEW DATE -- <br /> tiM <br /> TOTAL P-02 <br />