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10J3Bf2000 12:20 2094b8 <br />FIFTH FLOORP�V E0 <br />pl+TE <br />RECEIVED <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICE <br />ENVIRONMENTAL HEALTH DIVISION. OCT 3 0 2000 <br />304 EAST WEBER AVENUE, THIRD FLOOR ' <br />STOCKTON CA 85202 ENVIRONMENT HEALTH <br />(209) 468-3420 PERMIT/SERVICES <br />PUBLIC RECORDS RELEASE APPLICATION <br />„ a�9n dA+�+ct.�� BUSYAIESS/AGENCY .� r 02 <br />APPLICANT l� '`i°r►� ��'�`�f <br />ADDRESS I q <br />PHONE FAeSIMILG k -71& <br />TENTATIVE* APPOINTMENT DA ETIhIE �� <br />(Pirease give 7 to 7 D busine days from date of application su}antttalj <br />u CHECK BOX TO EXPEDITE REQUEST - $8T.00 FEE.- REQUESED IN 3 BUSINESS DAYS <br />,SIGNATURE OF APPLICANT DATE <br />ENVIRONMENTALr . PA1 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />0 OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGJRF-MOVAL) <br />❑ IjAZARDous N}A5TE GENERATOR <br />❑ TIERED PERMITTED FACILITY <br />❑ TATToGmODY PEIRCIHG <br />0 hiEPICALVIIASTEFACILM <br />List up to ten addresses in the space above. Solect the type(s) of files from the list above by chec(ar g, <br />the appropriate box(es). At least one file type MUST be selected. Fax to (go) 464-0138 ar malt to_the <br />address indll ted above. <br />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 afisr 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 />A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br />dpplication may be submitted when the file is available. <br />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 $57.00 deposit prior to review. <br />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />Appiications received after 3:04 pm will be processed the next business day. <br />❑ HOUSING ABATEMENT ❑ SOLS WASTE FACIL <br />❑ FOOD FACILITY ❑ souD WASTE VEHICLE <br />0 DOG KENNEL ❑ DAIRY NOV <br />-2 LLUI <br />❑ CHICKEN RANCH d PKG TREATMENT PLANT <br />❑ MOTEUtHOTEL ,_- ❑ PUMPER TRUCKtYARIXCHEMTOILETS <br />O PooliSPA ` ' ❑ LAND USE APPLICATION SITES <br />❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />1. <br />2. <br />3. <br />4. <br />5. <br />a. <br />CONFIRMED. APPOINTMENT DATE TIME <br />DA'Z'E CONFIRMED PHONE FAX <br />REVIEWED YES NO REVIEW ©ATE <br />INITIALS <br />