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Apr- 9 2003 3:22PM CON00H tAii►H iEcNNULUUitry <br />DATE RE SM0 ( � <br />—, ,� _ SAN JdA UIN COUN'TYPUBLIC HEALTH Sk- VICI~S <br />nl ��7 �� �D30AERR AvEu�LTHR_Fo4 ES WNTHILo <br />RPR 0 9 2003 STOCKTON CA 95202 i <br />(209) 468.3420 � <br />."NVIRONMENT HFARMBLIC RECORDS RELEASE APPUCiXTI N <br />�I VI CON 1>va- <br />APPLICNT' <br />A(Y eyi -- EUSINeSSIAGENCY _ <br />ADD RES.s f8$ f✓rvrN- Wes1- nw-i,6 0 Siet r7-- <br />PHONFE D5f $ FAcsimILE 7.0� z <br />TENTA7Nt�- ApP0NI ENY OATS ( o3 <br />(Pleac give 7 to id business days from date of api <br />. CHECK BOX TO EXPEDITE REQUEST - <br />SIGNATURE OF <br />U32.. S- t7L. Do?,ftta <br />NM- 1i< <br />17 .+ <br />3 <br />,00 FE9 •- REQUEST PROCF-55ED IN 3 <br />I►i <br />U <br />7 <br />5 <br />ZW LOG NUMER <br />X20 <br />IR35 <br />'/b s DO /511 q- <br />i sablnitfal) <br />ESS RAE'S <br />DATE 9 O 3 <br />rests $I17i= t fill STAI-i.- USE ONLY <br />PROGRAM E1.0Y1>E:tITS SEARCH <br />ENVIRONMENTAL HEALTH UnViSiON FILES <br />�G <br />-0,UNDi;f2G OUND TANK (UST) CLEANUP* SITE (LOP) 0 HOUSIFAG� !1 o WIJDsol-w wAsw VEHICLE <br />LOY <br />P OTHSR CLEANUP SITE (NON-LaP) j. <br />Ira. UNDERGROUND TANK (MQNTrdRINGIREMOVAL) 0 DOG KENNEL, ;i E7 DAIRY <br />R HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH 0 PKG TJWATt4 1Vr PLANT <br />J0 TIERED PERMITTED FACILITY 0 MOWMOTEL' ij Q 'PUOIpti RO <br />RTRUCiCrYAICtli:1 TOILE i <br />Q TATTOO/R40Y PEIRCING C3F oLdspA ;I ❑ LAIIID 4)sEAPPucAin0N srrES <br />❑ MEDicAL wASTE FAGILT[Y U PUBLIC RATER SYSTEM C] O;fiEfr (PLL AS£ SPECIFY ABOVE) <br />1, List up to ten addresses in the space above, Select the type(s) of fides frorn the i0 above by checking <br />the appropriate box(es).. At least one file type MUST be selected. LaA t X09 464W+7938 or mail to thr; <br />addr ss Indicated abav i <br />z, EHD will notify, the appilcarlt if any EHD files exist. An appointment for review will J341 confirmQd <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. Appoint ImonL-i .should be scheduled <br />accordingly. <br />3, A file that is actively being worked on by EHD staff may not be, immedlataly availahla 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 reorpnized by EHd s=aff at the expense <br />of the applicant. Future file reviews by the same applicant may require a y41,7.00 deposit prior to review. <br />S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next' business da.Y. <br />L;ONFIRMED APPOINTMENT DATE Tim- <br />DATE <br />iM-DATE CONFIRMED PHONE FAX -INITIALS <br />