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5- 1-02; 4:02AM; IT/EMC ;916 926 3341 iz ti <br /> 04/30/2002 15:51 4640138 EWIRONMEMAL HEALTH <br /> DATE RrcrlV <br /> 01 NU ER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> F-NVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468.3420 02 ;,' j(1 Pl'i l�: L�9 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �LF 11fL (,f/�" �j� yg�/jµJ BUSINESSIAGENCY rr <br /> ADDRESS J�2( tiJ G/> /�.�?� iU1�� 847`iff�� /4/Z. <br /> PHONE—_9&- FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME " <br /> (Please give 7 to 10 b�usinneess cay&rom d applica submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.0 E-REQUES OCE 3 B NESS DAYS <br /> SIGNATURE OF APPLICANT / ---- DATE 9� �p <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ,12 <br /> 2V <br /> 3 �G s a <br /> S <br /> -Sr-a o o 5 rv�i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1f UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 12 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY O MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> El TATTOOIBODY PEIRCING O POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ❑ OT"ER(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 checking <br /> the appropriate box(es). At least one file type MUST be selectet ix to (209)464-0138 or mail 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 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 />