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i <br /> 02/11/03 TUE 14:29 FAX 925 75.3 4985 TREADWELL & ROLLO z 001 i <br /> iii <br /> �•i.�,l�i..ar•w 1 I I� )! END yon NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH-DIVISION <br /> F L B i � � 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 ✓ <br /> (209)46"420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT d0. a5 BUSINESSIAGENCY I Yea({,y 4 RD t)-_ <br /> ADDRES5 ,.�L�ia_AT! <br /> PHONE _ �rJ- :yt`L.3-y98C� - 1 PAdsiMILE gzS-2�3-yq Ste- _, <br /> TENTATIVE`APPOINTMENT DATE Fe3o ZO O TIME 1 ,60 <br /> (Please give 7 to 10 businosa days rrom dale or application submittal] • <br /> F <br /> CHECK BOX TO EXPEDITE REQUEST 9.00 FEE- VEST PROCESSED IN 3 U SS DAY <br /> B SINE S <br /> SIGNATURE OF APPLICANT 1)ATI . ll <br /> FILE ADDRESS THIS SIDE ENO STAFF USE ONLY <br /> PROGRAM ELVAIENTS SEARCH <br /> 480 <br /> 57 W cS�- �• -� ' <br /> LA W,--S Q y /)'l <br /> 23 S �C' .Iat <br /> A. �a <br /> ENVIRONMENTAL HEALTH DIVISION FILE=S <br /> t4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C] HOUSING ABATEMENT 0 SOUI)WA.iTE FACILl1Y <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDi_RGROUNI]TANK(MONITORINGIREMOVAL)- ❑ DOG KENNEL. 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR d CHICKEN RANCH • ❑ PKG TREATMENT PLANT <br /> TIERED PERMMED FACILITY 0 MOTELIHOTEL C3 PUMPER TQUCKrYARDIGHEM TOILETS <br /> n TATYOOIAODY PEIRCING Cl POOLISPA ❑ LAND USE APPLICATION Srms • <br /> Ct MEDICAL WASTE FACILVFY ❑ PUBLIC WATER sYSTEr4 E3 OYHEA(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses In the space above. Select the type(s)or flocs from the list above by checking <br /> the appropriate box(es). At least one file type MUST bo selected. Fax to 209 464.0138 or mail to the <br /> address indit"atcd above. , <br /> 2. EHD will notify the applicant If any'EHD files exist, Ars appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. Tho files <br /> will be held for a maximum of five business days for review. Appolniments should be scheduled <br /> accordingly. P <br /> 3- A fife thatJ!j actively being worked on by EHD staff may root be immediately available for review- A new <br /> application may be submitted when the fife is available. <br /> 4. Any ilia not returned iN the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future Nle reviews by tho same applicant may require a $89.00 deposit prior to review, <br /> 5• 'TENTATIVE eppointrnent dates must be confirmed with t_HD staff. <br /> .6. Applleations received after 3.00 pm will be processed the next business day. <br /> r <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PRONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE �•" <br /> M n�jryrr`"-rr•--- <br /> Ta 7C1Hj Ul—h-MMU �HIM72 KIMJTAKM Q;rTAb4b T17:AT 7.G1A7/T.T./TT <br /> _ i <br />