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FRAM NOR Erwircrmental PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P2 SAN JtraQUIN COUNTYPUBLIC HEALTH S"E"RVICES ` Elio Via wwo -'[-ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, THIRD FLOOR 10,901 pCC STOCKTON CA 952023 2002 (209) 468.3420 PU,BLIC RECORDS RELEASE APPLICATION APPLICANT r-'r,��? //C-" ` 11';ii" / DUSINESWAGENCYjU.r'an I ADDRESS ZL l� . 0115 tpr� b,x � 9 y, PHONE 29 ,3n% -3•%O( FAC/SIMIL.EC)_ _ (-4T.ZE (, TENTATIVE' APPOINTMENT DATE ��^- G , Z Oo 3 TIME t • OD a• •„� . l �a{J �j 7G 5 (Pleaso give 7 to 1e 6us1iros9 days from date oI appllweon submittal) CHECK BOX TO EXPEDITE REQUES..T��$69.000�0 FEES OCESSED IN 3 BUSINESS OAI0' SIGNATURE OF APPLICANT ��L ` DATE /Z ,,.THIS SIDE D STA F USE ONLY PROGRAMELEMENTS if guisIL'Itilll►/117111GiTi rldn � .• lrrll9h,1!IIf�LU�/I�fiillll�� rol mi 171 N 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above. . 2- EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4_ Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future rile reviews by the same applicant may require a $89.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. G. Applications received after 3:00 pm will be processed the next business day. F JCONFIRMED APPOINTMENT DATE. TIME Ij DATE CONFIRMED PHONE FAX INITIALS I REVIEWED_ YES _ NO REVIEW DATE r u( n4ep7c •ate p�.wts<7— ENVIRONMENTAL HEALTH DIVISION FILES R UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY Jr OTHER CLEANUP SITE (NON"LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE i1Q UNDERGROUND TANK (MONITORINGIREMOVAL) Cl DOG KENNEL ❑ DAIRY Sf HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY 0 YATTOOMODY PEIRCING ❑ NOTEUHOTEL ❑ POOLISPA ❑ PUMPER TRUCK/YARDICHEM TOILETS • ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O LAND USE APPLICATION SITES 9 OTHER (PLEASE SPECIFY ABOVO} 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above. . 2- EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4_ Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future rile reviews by the same applicant may require a $89.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. G. Applications received after 3:00 pm will be processed the next business day. F JCONFIRMED APPOINTMENT DATE. TIME Ij DATE CONFIRMED PHONE FAX INITIALS I REVIEWED_ YES _ NO REVIEW DATE