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Sep 09 02 01 : 57p Caltrans 20994A7782 <br /> �9/09/20i.)226 4640130 p 1 <br /> ENVIRUMIENTAL HEALTH PAGE 01 <br /> SAN JCjAQUIN COUNTYPU13LIC HEALTH SERVICES <br /> ewe 4oc�ce <br /> ENVIRONMENTAL HEALTH DIVISION <br /> v 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> ` 2NUhLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Mlet.axJi rC0�M30+� ' <br /> OUSINESSIAG[NCY Cn.l ern q DCD'F. 01 TYaL1by)Er'F�^h��,LCA (7 <br /> PHONE <br /> 197 , ff. Char-Fcr HJ �j} —T� rf FP <br /> PHONE-4ky-[LIg,'f399 FACSIMILE12,0`11) SNS-7782. <br /> TENTATIVE'APPOINTMENT DATE_ S �{' Z3 I 'Locn- TIME 1400 <br /> (Pleas.orae710101) Iras:� , dal rspPII Ilon subml I) HEALTH <br /> CHECK BOX TO EXPEDME REQUEST- ES PERM p <br /> - YS / - <br /> SIGNATURE OF APPLIC DATE f 1Zdd 2 <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY /� <br /> PROGRAM ELEMENTS SEARCH <br /> G S Place S Hw y Stock` &-K . I( <br /> �M <br /> W <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONiTORINGIREMOVAL) ❑ OGG KENNEL rT DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELAIOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> CI CI MEDICATATTOOL <br /> WAS PEIRCMG O POOLISPA 13 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM O 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. Far to(2091464-0138 or mail to the <br /> address indicated above <br /> 2. END will notify the applicant If any END files exlsL 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 schedulod <br /> accordingly.' <br /> IJ. A file that Is actively being worked on by END staff may not ba Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any fife not returned In the same condition as released will be reorganized by END 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 END staff. <br /> S. 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 />