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09/17/2003. 08:37 FAX 209 9480621 Z004/004 <br /> DATE HSCFrvm ,••� v eHn LOG NUI+bEit <br /> , � �/ (r', SAN JOAQUIN COUNTYPUBLIC HEALTH.SFIRViCES <br /> Ind` � c;{l�;J�c ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 7 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> f�MRQWENT HEAE_TH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT _v l BUSINESSfAGENCY <br /> ADDRESS <br /> PHONE ztDC-? „q r0 k'33 S-.- „FACSIMILE '?-y'1 914 0 6 Z i <br /> TENTATIVE*APPOINTMENT DATE _��0 TUNE -2 Ulm ". <br /> (Please elve 7 to 10 business days from date of application subm ttal) <br /> CHECK BOX TO EXPEDITE REQUEST-387. F QUEST PF7CESSED IN 3 BUSINESS DAYS += t <br /> SIGNATURE OF APPUCANT DATE I 7L le'3 C�4� <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMEN175 SEARCH <br /> oo,L4 O Z f}U LAE-_ 5 i o —1z <br /> ✓✓ Lf G 14 0 4 -,S— L&:t4�, rA L_ <br /> aD J s7 <br /> Ll <br /> 3 I' << <br /> �r �r <br /> wtL�17/..1 WA <br /> r ,r � <br /> 3 3 0 2 1% ►r <br /> • V,�(I`;r ��_r tf�_k,�,l �� (�Ji� �I�� __� l�Y� � �.I;.�J�'F�tt/' �.C{ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT W SOLID WASTE FACILITY <br /> §' OTHER CLEANUP SITE(NO"OP) 10 FOOD FACILrrY 0 SOUR WASTEYEHICLE <br /> 4L UNDERGROUND TANK(MONITORINGMEMOVAL) Q DOG KENNEL M DAIRY <br /> �r HAZARDOUS WASTE GENERATOR C] CHICKEN RANCH 0 PKG TLTEATMENT PLANT <br /> O TIED PERMITTED FAC1Lr1Y A MOTELAiOTEL C] PUMPERTRUCkfYARDICHEM TOILETS <br /> E3 TATTOOfsOUYPEIRCING ❑•PdouspA la-(AND USE APPLICATION STIES <br /> ❑ MEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEM a OTHER(PRASE SPECIFY AsavE) <br /> 1. List up to ten addresses In the space above. Select the typ (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)-4§4-0138 or mai) to tile_ <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 avallable. <br /> 4. Any file not returned In the some condition as released will be rearganited'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 /> REVIEM0 YES NO REVIEW DATE �� T� <br />