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E J 11 EHL)LOG NUMBER <br /> \ SAN JOAQUIN COUNTY - <br /> EI ..ONMENTAL HEALTH DEP,,.ART _ , <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 ; <br /> MAY 0 6 2003 (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAN'TLIII BUSINESSIAGENCY Wk jQ 1ACD of V 6� <br /> ADDRESS S <br /> `R 31��4lill <br /> PHONE ; Orl `1 10 9 t ���FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME C <br /> (Please give 7 to 10 business days from date of application submittal) <br />+ )<CHECK BOX TO EXPEDITE REQUE T-$89.00 FEE—REQUEST P ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /ti' DATE S Ul CJ <br /> I! <br /> I FILE ADDRESS !I THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1 S <br /> 7 9n <br /> IL <br /> e_-N r% n n.,, n r5in I rrPprnn)) <br /> °1 <br /> l <br /> r <br /> 3 2003 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> X❑ OTHER CLEANUP SITE(NON-LOP) a FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIRE M OVAL) d DOG KENNEL 3 ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEUHOTEL ! ❑ PUMPER TRUCK/YARDICHEM TOILETS u <br /> ❑ TATTOOlBODY PEIRCING ❑ POOLISPA i ❑ LAND USE APPLICATION SITES <br /> i ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) _ <br /> !i <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list above 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. 1l <br /> li 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.11Appointments should be scheduled <br /> accordingly. I! <br /> 3. A file that is actively being worked on by EHD staff may not lie Immediately available for review. A new <br /> application may be submitted when the file is available. i <br /> 4. Any file not returned in the same condition as released will 6e' reorganized by EHD 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 /> 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 /> 3� <br /> CONFIRMED APPOINTMENT DATE TIME <br /> f 3� <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> it <br />` REVIEWED YES NO REVIEW .DATE r <br /> EH0 4J1-02-006 <br /> f X26R003 <br />