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03/29/2002 16:01 209467. AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED "► *40we tNU LVV Numnan <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION taiIMCIN o <br /> T WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 / <br /> 209 468-3420 n <br /> P BLI RECORDS RELEASE A T `IV <br /> APPLICANT USINESS/AGENCY �J <br /> ADDRESS 493 L'�Ahlj f N OZ <br /> ao q) y� 7 v K� FACSIMILE / _ h <br /> PHONE <br /> TIME <br /> TENTATIVE' DATE a//W� r� r Il' <br /> I T <br /> (Please " e 7 olabbalnes da om d f applica on submittal) <br /> CHECK BOX TO EXPEDITE REQU T-$7 .00 FEE�EQU C t3 INE33 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> r7 I It li 11 <br /> It <br /> 3Sa- <br /> i k <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL d DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) 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 aboyQ• <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 appilcation. 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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 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 INrrlALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 09 1A 01!06100 <br />