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MAR-08-2002 16:27 CRMHRIR 1707 935 6649 P.01101 <br /> UtU lVG NUMV4A <br /> SAN JO#IN COUNTYPUBLIG HEALTH SEf*ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 3pgFAST WEBER AVENUE,THIRDFLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> 02 P1�,R -B Pte tp5bLIC RECORDS RELEASE APPLICATION 1 <br /> APPLICANT x.0-61-tet Cf° BUSINESS/AGENCY <br /> ADDRESS CA <br /> 20 Iktv.¢ S•t-r-eat Stsr+d`n^a <br /> PHONE (-7o-7) FACSIMILE 001 �C - b1649 <br /> TENTATIVE'APPOINTMENT DATE 116E WOO <br /> ( ea v 7 to nyf`��days�a/te of BP kation Su6mittaq <br /> © CHECK BOX TO EXPEDITE REO➢EJrO�FEE4t7t5T PROC^�SEO IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT \Al" a�-l. r CIO DATE <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> / PROGRAM ELEMENTS SEARCH <br /> 'll00 More tL c k N <br /> ✓'� 441, W. • h is r+w W n4-,. S c t 1 <br /> ✓✓ O W. Gar W <br /> U,nCOIV% S <br /> L� to SfiteF 14 <br /> 10 <br /> • <br /> N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> V21.1D <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT CI SOLID WASTE FACILITY 1 <br /> A,R <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 7UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMnTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKrYARD/CHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING Cl POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 13 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)464-0136 or mail to 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 EHO 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$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 CONPtRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> TOTAL P.01 <br />