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DATE RECEIVED EHD LOG NUMBER <br /> v SAN JOAr)UIN COUNTYPUBLIC HEALTH SF"YICES <br /> l' <br /> E,,IRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> APR 0 1 2004 STOCKTON 95202 /�_ <br /> (209)468-3-3 420 I /v/J <br /> nE:;..Lrl PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT� �UI Alms BUSINESS/AGENCY_ <br /> _PhOS' nY1P Lr1C <br /> ADDRESS It>�Lifl 41�' 3 <br /> PHONE X121 FACSIMILE :1)tI -CoGq -W1"]7 ' <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$7788..00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `�� ��— DATE 3- ISI J <br /> FILE ADDRESS <br /> 5019 E. �cahant Tio�d Cxlt CR 95Co3 r w�..; <br /> O) L.ol„er SnCnorrlent0 S)-nCkton <br /> 'DLILILIRS. Air <br /> II v <br /> 9 s <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> la, OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> $ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Jffi HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Cl PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ 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 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 $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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01/05/00 <br />