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11/14/2002 08:18 707452841A JEAN HUGHES P E 01 <br /> 7MMI ll O SAN JOAQUIN COUNTYPUBLIC HEALTH SERVi ff <br /> LIS - 00% <br /> ENVIRONMENTAL <br /> HEAL <br /> THDIISIO <br /> 304 EAST WE®ER AVENuE, �IRD <br /> NOV 14 2002 <br /> STOCKTON CA 06202 <br /> (209) <br /> FNVIRvNMENT HEALTH U LIC RECORDS RELEASE APPLICATION <br /> DF , <br /> APPLICANTVd <br /> SUS Y <br /> ADDRESS r <br /> PHONE - FACSIMILE <br /> TIME � <br /> TENTATIVE!APPOINTMENT DATElaation oubrnittd) • <br /> (Pleoee give 7 to 1O bwlne . d.rs hom ot.of appl <br /> � v <br /> CHECK SOX TO EXPEDITE REQUEST-$N.00 FEE-R9 UEBT 1111MESSE0,IN 3 BUSINESS DAYS I 1 <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS M�`�HIEN SAFF�SSEARCH <br /> 6 <br /> ee <br /> O <br /> 1E- r E NMENt HUTH DIVISION FILES <br /> ❑ SOLID WASTE FACILITY NOV 18 2002 <br /> tHAZARDOUS, <br /> IERGROUND TANK(UST)CLEANUP srrE(LOP) ® FOOD FA ILSATEMENT 0 SOW WASTE VEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑ FACILITY 0 DAIRY <br /> ERGROUND TANK(MONITORING/REMOVAL) ® ooa KENNEL O PKG TREATMENT PLANT ' <br /> WASTE GENERATOR In CHICKEN RANCH O PUMPER TRUCK/YAMWCHEM TOILETS <br /> ED PERTAWMD FACILITY Q MOTELVOYEL D LAND USE APPLICATION 8iTE9 <br /> C3 TATTOOIRODY PEIRCING . 0 P A C1 OTHER(PLEASE SPECIFY A$OVE) <br /> 0 MEDICAL WASTE FACILITY in PUBLIC WATER SYSTEM <br /> 1. List up to ten addresses In the space above. $elect the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax t (20 40-0121 gr m J" <br /> 64 <br /> rel�.lrtdlE;f ed a ve. <br /> 2. EMD will notify the applicant if any END 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 END staff may not be immedlatsly available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the some condition as released will be reorganized by END 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 /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed tie next business day. <br /> CONFIRMEDAPPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />