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SAN JOAQUIN COUNTY <br />EN '; ONMENTAL HEALTH DEPART . _ <br />(-" E (I V E D 304 E Weber Ave 3' Floor Stockton, CA 95205 <br />- (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.caus/ehd <br />�......�-'MAY 0 6 2004 <br />PUBLIC RECORDS RELEASE APPLICATION <br />�o .1 — V11 1"I . . , q+� BUSINESS/AGENCY: C'� J <br />APP nNT/2W _s�_h76 <br />ADDRESS: % <br />PHONE:�2- ? 1 L t 7 b 3 FACSIMILE: 2 �j�) �t Z 2— <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal) <br />Eml <br />13 CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE– REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Department Use Only <br />UNIT <br />❑ Unit 1 <br />❑ Unit 2 <br />f[r <br />©'' j (05 a9 lfluiise. <br />of !b yo��5 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />® HOUSING ABATEMENT <br />13 SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -.OP) <br />® FOOD FACILITY <br />® SOLID WASTE VEHICLE <br />DERGROUND TANK (MONITORINGIREMOVAL) <br />® DOG KENNEL <br />❑ DAIRY <br />US WASTE GENERATOR <br />® CHICKEN RANCH <br />0 MOTELAiOTEL <br />0 PKG TREATMENT PLANT <br />13 PUMPERTRUCMARD(CHEM TOILETS <br />RMITTED FACILITY <br />VODY PIERCING <br />® POOLISPA <br />a LAND USE APPL.ICATM SITES <br />M MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />1. Ust up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax 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 END staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $93.00 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 />�C0NFJ,R. ,MSD. APINTMI=NTDATE t t� TIME _ <br />Y <br />.SATE CQNFIRMED :. - P ONE FAX INITIALS <br />:. <br />:t?EVIEIIVEO YES NO REVIEW DATE. :. :. <br />EHo 48-024MG <br />SM12 3 <br />