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FROM : NOR Erwirorrnental PHONE N0. 209 369 4228 <br /> vwleaal:rvtu Dec. 23 2002 12:24PN P3 <br /> • �( r SAN JO-AQUIN COUNTYPU13LIC HEALTH SERVICES ENO 40C HVNHER <br /> Il l�_'fir `(� , <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR loqtr DEC 0 200? STOCKTONCA95202 <br /> (209)468-3420 <br /> j;P,,UBLIC RECORDS RELEASE APPLICATION <br /> I1�I /! 01�)2L1 <br /> APPLICANT /�L BUSINESS/AGENCY <br /> ADDRESS`ZZ n( �G-L.,... 1,.d; r r^ q '-752-q6PHONE (275)-1197--,3761 FACSIMILE CgTQg) 3( `7—HZ.Z3q <br /> TENTATIVE'APPOINTMENT DATE ZG83 TIME / (�D��y _ I-� a3 � I�✓ <br /> (Please glue 7 to 10 hustness days tom date of application submittal) <br /> • <br /> CHECK BOX TO EXPEDITE REQUEST-58�E-RE T P 0CESSED IN 3 BUSINESS DAYS un 5111, <br /> ` <br /> SIGNATURE OF APPLICANT DATE �2 ZU Z <br /> FILE ADDRESS THIS SIDE EHD STAFF VSE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> iC r ��. L',d: C/9 N V V V <br /> N <br /> 3 <br /> Lj <br /> +� 1 <br /> 5 9 ff <br /> to �r� n <br /> 7 0 -Nor v■^' <br /> b 6L CQ W <br /> cl ✓ OYE <br /> P lie <br /> L <br /> r .,tare des <br /> 00 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 19 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 1Z <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL O PUMPER TRUCK/YARD/CHEMJTOI�LETS❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SIT❑ MEDICAL WASTE FACILITYPUBLIC WATER SYSTEM PW OTHER(PLEASE SPECIFY AB <br /> �. 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 (east one file type 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 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 fila 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 $89.00 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 I APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Iai ISM'. <br />