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Ultl uti.NUMNEd <br /> OATS RECEN6D <br /> J( 'JUIN COUNTYPUBLiC HEALTH SL '!ICES <br /> J' I rNVIRONMENTAL HEALTH MIMI. ��� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> AUG 1 6 2001 STOCKTON CA 95202 <br /> (209)4683420 <br /> 1- h PUBL.iC RECORDS RELEASE APPLICATION <br /> OBD�tUii,^dn MPm1Q ln� <br /> APPLICAN HPOUSINESSIAGENCY Q ,&�` IIf pf <br /> 837 Sh2uJ �Poad S-to u—�r� /5l • <br /> ADDRESS^p� <br /> PHONE SO 7IQ ( U�_ FACSIMILE UG <br /> TIRE [, <br /> TENTATIVE'APPOINTMENT RATE I) <br /> date Of apPlicxfioe sanmlftal} <br /> (Please give T to 10 6usln da <br /> uvrrs <br /> CHECK BOX TO EXPEDITE REQU Sze o0 FEE-REQU AD _DIN 7 BUSINESS DAYS <br /> GATE <br /> SIGNATURE OF APPLICANT <br /> FILE AnDRESs <br /> RD <br /> rLA <br /> o erriIfr n <br /> N <br /> J �1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 'V 4DF RG �y ❑ HOUSWG ABATEMENT ❑ SOLID WASTE FACILIIY <br /> OTHER CLEANUP <br /> TANK(UST)CLEANUP SITE(LOP} ❑ FOOD FACILUY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP} ❑ DAIRY <br /> Cl DOG KENNEL <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) InPKG TREATMENT PLANT <br /> 11 CHICKEN rII <br /> HAZARDOUS WASTE GENERATOR CI MO <br /> KEEN AN ❑ PUMPER TRUCWyARn/CHEM TOILETS <br /> 13TIERED PERMITTED FACILITY POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PCIRCING ❑ <br /> PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. thPects)o filesFax from <br /> m the list a04-0T3$vo bm 1 checking the <br /> the appropriate box(es). At least one file type <br /> MUSTe se <br /> address indicated above <br /> 2. EHD will notify the applicant if any EHO 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 hold 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 ENP staff may not be Immediately available far 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$70.00 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 /> REVIEWED YES NO REVIEW DATE <br /> Er ua t• vinLon <br />