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END 4OG NUMBER <br /> SAN QUIN COUNTYPUBLIC HE44T <br /> VIRONMENTAL HEALTH <br /> a 304 EAST WEBER AVENUE, 20STOCKTON CA 95202(209) 468-3420PUBLIC RECORDS RELEASE <br /> ENVIRONMENT HEALTH <br /> APPLICANT�I��U!U'n� Z- BUSINESSIAGENCY .. RVIG`S <br /> ADDRESS �L)-Z,­'% I �2.Y�1'l>♦/Q L <br /> PHONE 4A( ,,(c- -I 111 FAOSIMtt- *Z()C) `I b b -7 a - I <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 t 10 business Iroe of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89U0 FEE-REQUEST PROCESSED "BUSINESS DAYS <br /> SIGNATURE OF APPLICANTY' DATE <br /> ZZ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 775- E / - < <br /> ENVIRONMENTAL HEALTH DIVISION FILES. <br /> ❑ <br /> UN RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> M❑ ER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ERGROUND TANK(MONITORINGIREMOVAL) E3DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY 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 $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 /> F <br /> APPOINTMENT DATE TIME <br /> MED PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br />