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02/03/2004 13:11 FAX 209 9180621, 002%002 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES � ER <br /> ENVIRONMENTAL HEALTH DIVISION <br /> FEB 0 3 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEH'I H (zos) 468-3-420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ )LI.-k 7tAQl.�j� BUSINESSIAGENCY <br /> ADDRESS 2�75 F. M`�R-I—Lf._ C` rD CJt <br /> PHONE Ri(�` 13�� FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE Z/l 3 to Tare 1 <br /> (Pleaso give 7 to 10 business days from date of appiicaHon submittal) <br /> CHECK BOX TG EXPEDITP REQUESY_sg7,00 _REgUE T OCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z v q <br /> I 1� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> I� S <br /> PROGRAM EI.EMENTS SEARCH <br /> FE9 4 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(USTI CLEANUP SITE(LOP) 0 HOUSING ABATEMENT - IID SOLID WASTE FACILITY <br /> q: OTHER ct-EANUP'SRE(NON-LOP) - d FOOD FACIURY - ❑ SOUD WASTE VEHICLE <br /> al UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNET. ® DAIRY <br /> 19 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH F PKG TREATMENT PLANT <br /> ❑ TIERED PERa Mrn rACItrrY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIDODY PEIRCING ❑ POOVSPA .-- 1 P LAND USE APPUCATON SHES <br /> O MEDICAL WASTE IFACILITY 0 PUBLIC WATER SYSTEM O 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 (2091464-0138 or mall to the <br /> a ddressilndi%ted 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 Field 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 $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 /> �f <br /> CONFIRMED APPOINTMENT DATE TIME,. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> 4. <br /> REVIEWED YES un g2rmpw nATr <br />