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09/17/2003 09:36 FAX -209 948061916 U002/004 <br />0.47E 6iaC�@O amb LOG mumagR <br />1�' DSAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />S E P 7 2003 STOCKTON CA 95202 <br />(209) 4653420 <br />Vpo�IMENI'HEA HPUBLIC RECORDS RELEASE APPLICATION <br />APPUCANT I p2L BUSINESSIAGENCY <br />-me 81ii <br />PHONE FACSIMILE ?--69 10 6 1- <br />TENTATIVE* APPOINTMENT DATE TIME I <br />(Please give 7 to 10 bUsInmdays from date of j-pplIcaflon ZZm- <br />1-1 CHECK BOX To EXPEDITE REQUEST -S87.00 <br />SIGNATURE OF APPLICANT <br />12INZ <br />PROCESSED IN 3 BUSINESS DAY <br />t ZJ0 <br />S <br />DATE <br />THIS SIDE EHD STAFF USE ONLY I <br />PROGRAM ELEMENTS <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />1% UNDERGROUND TANK (UST) CLEANUP SITE (LOP) C1 HOUSING ABATEMENT 0a SOLID WASTE FACILITY <br />6? OTHER CLEANUP SITE (NON -LOP) 13 FOOD FAQLITY CI SOLID WASTE VEHICLE <br />a UNDERGROUND TANK (MONITORINGIREMOVAL) C] DOG KENNEL Ca DAIRY <br />0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH IN PKG TREATMENT PLANT <br />E3 TIERED PERMITTED FACILITY 13 MOTELAiOTEL C3 PUMFERTRUCkIYARDICHEMTOILETS <br />C3 TATTOOIBODY PEIRCING C3 -pdoLiSPX 93 *LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY C3 pUBUCWATER SYSTEM 13 OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses In the space above. Select the "(s) of files from the list 2bovi by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail tothe <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 oft 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 />IWO <br />2 <br />Mix <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />1% UNDERGROUND TANK (UST) CLEANUP SITE (LOP) C1 HOUSING ABATEMENT 0a SOLID WASTE FACILITY <br />6? OTHER CLEANUP SITE (NON -LOP) 13 FOOD FAQLITY CI SOLID WASTE VEHICLE <br />a UNDERGROUND TANK (MONITORINGIREMOVAL) C] DOG KENNEL Ca DAIRY <br />0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH IN PKG TREATMENT PLANT <br />E3 TIERED PERMITTED FACILITY 13 MOTELAiOTEL C3 PUMFERTRUCkIYARDICHEMTOILETS <br />C3 TATTOOIBODY PEIRCING C3 -pdoLiSPX 93 *LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY C3 pUBUCWATER SYSTEM 13 OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses In the space above. Select the "(s) of files from the list 2bovi by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail tothe <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 oft 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 />