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EMI yOG 11U..101 <br /> SAN QUIN COUNTYPUBLIC HEALTH -RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JAN 0 6 2003 v 304 EAST WEBER AVENUE,THIRD FLOOR 1109 <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEAS�(EI APPLICATION <br /> APPLICANT ' `-��j-rI QBUSINESSSI/AGENCY <br /> ADDRESS J-I <br /> PHONE 2.O 7 - 5 foo -3y-2`��3• FACSIMILE <br /> C-G/f <br /> TENTATIVE'APPOINTMENT DATETIME I-I-I'17L ,dtl�' <br /> (Pleaso givo 7 to 10 buslnoss days from data of appllcallon submlllal) <br /> CHECK BOX TO EXPEDITE REQUEST-$119.00 FEE--REQUEST PROCESSED IN 3 BUSINESS DAYa ',N/ <br /> i � �I <br /> SIGNATURE OF APPLICANT DATE A <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 2 88 t AV(1A)e- 00411 Sxn J� .Col. <br /> r <br /> LCv:l Pk -A LE-ve/ r.L;C <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> g}�NDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> I3 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> EYHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 11�TIERED PERMITTED FACILITY ❑ MOTELIHOTEL O P�IMPER TRUCK/YARDICHEM YOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA Q'LANG USE APPLICATION SITES <br /> 11 MEDICAL WASTE FACILITY 13 PUBLIC WATER SYSTEM ®OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton 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 mall 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 ton (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 now <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 expanse <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 /> G. 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 /> •II 11.111f�r -r . <br />