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01/2U/2002 13:29 20946711 AGE STOCKTCN r'cw� JLi 11� <br /> 01/28/20IVM EHO LOG NUM5E <br /> \ `\` JOAQUIN COU TYPUBLIC HEALTH SE vICES <br /> ENVIRO304 EAST WEB DIVISION <br /> WEB R AVENUE,THIRD Fbl � r ' <br /> STO KTON CA 95202 L� <br /> � ( Q� ( 09)468-3420 <br /> PUBLIC RECORD RELEASE APPLICATION <br /> APPLICANT 1..�\V�f� q. 6USIN SSIAGENCY D• �• <br /> ADDRESS <br /> PHO <br /> , Q� FACSI ILE <br /> sr ENTATIVE'APPOINTMENT DATE TIME Y • I <br /> ti (Please give T to 10 busine s days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$T O PEE—REQ EST PROCE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z g OZ <br /> FI E ADDRESS <br /> 0Sol ` O <br /> J � <br /> ENVIRONMENT L HEALTH DIVISION FILES JAN 31 2002 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HO SING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FO D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DO KENNEL d DAIRY <br /> HAZARDOUS WASTE GENERATOR 17 CHI KEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACIU Y ❑ MO ELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 4 TATTOOIBODY PEIRCING ❑ PO USPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PU LIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space abo e. Select the type($) of files from the list above by checking <br /> the appropriate box(es). At least one file ype MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fi es exist. An appointment for review will be confirmed <br /> approximately five business days but no ater than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five busine s days for review. Appointments should be scheduled <br /> accordingly. ' <br /> 3. A file that is.actively being worked on by HD staff may not he immediately available for review. A new <br /> application may be submitted when the fi is available. <br /> 4. Any file not returned In the same Conditio as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be onfirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 0910 <br />