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DAM RECEI> b 1 ' ulo t.�;NJnlCili <br /> 5 N RAQUIN CDUNTYPUBLIC HEALTH SOV(CES <br /> ��' ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR 5q <br /> AUG 1. 6 2001 / STOCKTON CA 95202 <br /> (209)468-3420 <br /> Ei CiH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT0USINE /" <br /> SSfAGENCY�?10'J t�r20ErLII%PdA1i'1E�1 Q�,.T� <br /> ADOKESS VAA11 koad r C9 J/` S— <br /> PHONE �Oq yl�rl ~/DO(o FACSIMILE ` 7Ille? e <br /> ¢.S UC <br /> 19 9 h <br /> TENTATIVE'APPOINTMENT DATE TWE . 1 <br /> (Please give T to 10 busln s da m date of application bunmatai) <br /> W/ <br /> 1A CHECK BOX TO EKP501TE REgU 5 L[ <br /> $79.00 FErft Eau PROC ED IN 3 BU51NESS DAYS f,7 <br /> SIGNATURE OF APPLICANT DATE u <br /> FILE ADDRESS <br /> no O_ <br /> T" rr <br /> 47405 AF nt 'nrS7` Sr- <br /> A <br /> k <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP 51TE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILRY <br /> r7}"pQLI(OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE vEHiCLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH n PKG TREA MENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCWYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ 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)464-01311 or mail to tho <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 the that is actively being worked on by EHD staff may not be Immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4, Any rile 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$70.00 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 /> r m t. 411.v - - <br />