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SAN JOAQUIN COUNTY <br /> ENVIF AMENTAL HEALTH DEPARTME� <br /> 304 "AST WEBER AVENUE, THIRD FLOOR <br /> JUL Q 8 2003 STOCKTON CA 95202 <br /> (209) 468-3420 464 <br /> !!'1li �?lJv?i_'ili i E.l�L1Fi PUBLIC RECORDS RELEASE APPLICATION <br /> )l I1VIV <br /> APPLICANT ICON L14LE5Nc 1 BUSINESS/AGENCY G��SN�V CoA/S�IGTi�II <br /> ADDRESS P//- O . ISO)< 3?q4- TGlR LO GK <br /> PHONE �Qu ��r/��3 FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME _ <br /> (Please Hive 7 to 10 business days from date of application submittal) <br /> • <br /> CHECK BOX TO EXPEDITE REQUEST- .00 FEE04/ ST PROCESSED IN 3 BUSINESS DAYS � 13 <br /> SIGNATURE OF APPLICANT DATE41115v �'3 ..�(�'0 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> / role <br /> vRrnon/ CHuRt// - ;t 7/5-0 W I t-KeWia IV N/A Y rflAel <br /> GALV It Bt vi_E - /9&2/ n1. . 2. A o0 <br /> EA R C E Or". e,4yaek- 7/ Al. Gok ea a[J p <br /> HY W94-1- 1-00 ANO SE (4 <br /> 13 0 00 SOUTH HAXLRO, d <br /> /1000 - /3o00 VALPIGO <br /> 210 00 - 2 900 o eatm4L AtO L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0, SOLID WASTE FACILITY <br /> k7 OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ,C1, SOLID WASTE VEHICLE <br /> Q_ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0. DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH -0- PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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 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 $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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHO 48-02.006 <br /> 0/26/2003 <br />