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AGE STOCXTON i PAGE 02 <br /> U / SAN JCAQUIN COUNTYPUSLIC HEALTH SERVICES <br /> . ENVIRONMENTAL HEALTH DIVISION <br /> OCT 18 2000 304 EAST WEBER AVENUE. THIRD FLOOR <br /> STOCKTON CA 95202 <br /> .:NVIRONMENT HEALTH (209) 468.3420 <br /> (TiSFRN11CFS PUBUC RECORDS RELEA`S^`rEJ APPLICATION � y <br /> APPLICANT 1/J BUSINESS/AGENCY tit f�UClflf_P!f (,WoC/I(.I/�^F�ao/�'IeA <br /> ADDRESS y0o s (t1 '' so u OA Sa05- <br /> PHONE a? � /Q Q FACSIMILE /y u //(p <br /> TENTATIVE'APPOINTMENT DATETIME <br /> (Please give 7 to 10 business days from rate of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST•$78.0 EE—RE EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �. (� DATE !9) I Z pp0 <br /> FILE ADDRESS <br /> 0 <br /> �f S <br /> ENVIRONMENTAL, HEALTH DIVISION FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> K OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> l8 UNDERGROUND TANK(MONITORINGIR£MOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 19 14AZAJIDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> In TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARWCHEMTOILETS <br /> ❑ TATTOO/UODY PEIRCING ❑ POOUSPA ❑ LAND US E APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ CTNER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addre$ses in.the space above. Sefect 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)464-0138 or mait to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any Etat 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 EHD 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 releasedwill be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5, *TENTATIVE appointment dates must be confirmed with EMD 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 /> EH OR t1 O1g3gU <br />