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Rug 12 02 12: 31p Horizon Env. Inc 916 939 2172 P• 1 <br /> ' 08/12/2002 12:35 46401 ENVIROFMENTAL HEAL' <br /> wit xa�r�vt0 .J <br /> SAN.JbAQUiN COUNTYPUBLIC HEALTH SERVIC9 r&Y <br /> S ENVIRONMENTAL HEALTH DIVISION <br /> 904 EAST WEBER AVENUE,THIRD FLOOR AUG 12 2002 <br /> STOCKTON CA 95202 <br /> (209)468.3420 ENVIRONMENT HEALTH <br /> ^PPU`BBL,ILC� RECORDS RELEASE APPLICATIOIfERf ' <br /> APPLICANT V`A -Q�`t— {�•I K r BUSINESSIAGENCY or1 d p��IV{�L� <br /> ADDRESS 5a ) I 4 Llo1pLaen & <br /> PHONE 01- �1 7o FACSIMRE IG• -Z1 L 6Z <br /> TENTATIVE*APP04NI Mli OATS wit Here I'� <br /> lNefse plve 7lo til bu Ss days from of a Ieallon TvGml ep <br /> CHECK BOX TO EXPEDITE RFOIIFST.te9.0fW E S 0� SEO �IN AY6 7 <br /> SIGNATURE OF APPLICANT DATE _I Z' O <br /> FILE ADDRESS THIS SIDE EHO STAFF USC ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> N <br /> t <br /> LUU1 <br /> ENVIRONMENTAL.HEALTH DIVISION FILES v 1 <br /> Ar UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT C3 SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY (7 SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINCMEMOVAL) O DOG KENNEL O DAIRY <br /> O MAURDODS WASTE CENENATOn 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTELMOTEL O PUMPER TRUCK/YARDICHEM TOILETS <br /> O TATTOOIBODY PEIRCING D POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> • T. List up to ten addresses In the space above. Select the typo(s)of fifes from the list above by checking <br /> the appropriate box(es). At least one file type MUST he selected. Fax to 1,2091464-0138 or mail to the <br /> address indicated above. I - <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 lhat.1s actively being worked on by EHD start may not be immediately available for review. A new _ <br /> application may be submitted when the fib 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 /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after S:DO 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 />