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091/17/2003 09:36 FAX 209 9480&9-1 002/004 <br /> anre EKO LOG HUMaER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> LE <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> S E P 1 7 2003 STOCKTON CA 95202 <br /> 1H (209)46&3420 <br /> --.-NV1Q0KMENT HEAL PUBLIC RECORDS RELEASE APPLICATION <br /> --11 <br /> D[ 1"T�iV1171-0 <br /> APPUCANr BUSINESS/AGENCY <br /> ADDRESS <br /> PHONE 2o9 /aLf2d 17 LI S FACSIMILE 2-09 ju I <br /> TENTATIVE*APPOINTMENT DATE � L TIME 0 1 <br /> (Please give 7 to 10 business-days from date of application submittal) q <br /> CHECK BOX To EXPEDITE REQUEST-$1T.00ROCESSED IN 3 BUSINESS DAYS <br /> _��REQUEST P 0 <br /> SIGNATURE OF APPLICANT DATE 1// 7 <br /> 7 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> A LS 1 -(3 Qg�r4 C Mr -ML <br /> M MR <br /> 32.1-1 tA. CA.L:Lfl2a--4-1P-. Y <br /> rA fit . <br /> 12 <br /> 5,(0 'Nj <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 01 SOLID WASTE FAciLrry <br /> IW OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 91 UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL CA DAIRY <br /> 4 <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH IQ PKG TREATMENT PLANT <br /> 0 TIERED PERmmmo FACILITY 13 MOTELIHOTEL C3 PUMPER TRUCKfYARD(CHEM TOILETS <br /> 0 TATTOOMOOY PEIPCING C3-PdOLjSPX93'LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY C3 PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1, List up to ten addresses In the space above. Select the type(s)of files from the list abov6 by checking <br /> the appropriate box(es). At least one file type MUST be selected. Eax to(209)464-0118 or mail to the <br /> address ndi <br /> -Ij ca-ted 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 fora maximum of rive 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$87-00 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 />