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SATE nttc:veu W KEG_NUMBER <br /> SAN JC JUIN COUNTYPUBLIC HEALTH SF VICESL, - <br /> arrVIRONMENTAL HEALTH DIVISIOir- P <br /> 304 EAST WESER AVENUE,THIRD FLOOR r " <br /> STOCKTON CA 95202 6 AFF2 7 2001 <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATIOI IVV'r (�;q�'v'�Itil�' sr-p;_Th <br /> APPLICANT - U C rAeX— CCndCX �hGllQ�j <br /> ADDRESS <br /> PHONE_ FACSIMILES r�. 7 <br /> TENTATIVE*APPOINTMENT DATE TIME wlyl *ror� <br /> (Please give 7 to 10 business days from date of appbcatlonZbmiftal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$87.00;:U-PEQUESTPROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT —Tlrfri(g),,,L,--JZAxjrJ DATE 3-m-q-01 <br /> FILE ADDRESS THIS SIDE:EHD STAFF USE <br /> PROGRAM ELEMENTS L <br /> 303 <br /> IN Q <br /> Mob F-. S Z <br /> vdn � 2 1 <br /> 1 <br /> I � ;` ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> %OTHER CLEANUP SITE(NON-LOP) 0 F00D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MUNITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> J�rHAZARDOUS WASTE GENERATOR D CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEUROTEL 13 PUMPER TRUCKIYARDICHEMTOILETS <br /> ❑ TATTOOMODY PEIRCING 17 POOLISPA - - .'LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ; UN;{.IC_YYATERSY$TEdI-.: M 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 typo MUST be selected. Fax to(2091464-0138 or maillo 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 EMD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any fila 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 $87.00 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 /> PF1NFWFn vac Nn acvuw nA1rc <br />