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rran'I : NOA Environmental PHONE NO. : 209 369 4228 Dec. 03 2002 02:54PM P2 <br /> eno toc mwee <br /> UAIEHECENEDtt�'' <br /> In)T,,���'���� �OENVIRo MENTAL. HEALTH DIVISION <br /> RVICES <br /> DEC 0 3 2002 v 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 V <br /> oI�.) (209)468.3420 <br /> • fdIV�ENT I-fEALTH <br /> FFFJ01J/i FpvICf�RQBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT i48� �rw,-C-'�w'ld OUSINESSIAGENCY JDA- ENVIP_0rj MEN"TAt_ <br /> ADDRESS �� uS LA-AJE L01>1 <br /> r%e1) 714+ <br /> PHONE <br /> •- T •p FACSIMILE (7-,D9) 3"` 1 �TZ�.•8 <br /> TENTATIVE*APPOINTMENT DATE Imo-•• I Z-•'OZ TIME to'.60 <br /> (Please give 7 to 10 businesS days from date Ot application y suubmittal2514 <br /> )•�,'I-f)pZ�(� J <br /> El CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN Wl filS, <br /> SIGNATURE OF APPLICANT =� DATE <br /> FILE ADDRESS THIS S1DE EHO STAFF USE ONLY <br /> 1-OdI QS PROGRAM ELEMENTS SEARCH <br /> ' )�L29 /•1•Gvi Avc. 1�-55°S N. Gv+►d <br /> 1 c,M&.h W <br /> Rd <br /> $0 Z <br /> � 133 E. Tv✓ww Rd. <br /> ENVIRONMENTAL HEALTH DIVISION FILES VI i4 i<- R'v V%A;kS <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> % OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Vq TIERED PERMITTED FACILFTY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING - ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM �t 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 /> 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 Nle 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 /> 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 />