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DATE RECEIVED LO "'E, <br /> SAN JOA COUNTYPUBLIC HEALTH SE ICES <br /> ENVIRONMENTAL HEALTH 5LOI <br /> ST WEBER AVENUE, 20 <br /> STOCKTON CA 95202 <br /> Rv <br /> V&0 - 10 <br /> . (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIO14 9 Q 2002 <br /> APPLICANT__ FGLt e_� BUSINESS/AGENCY ,��,,,,� <br /> t� - S3c11 Y._3_Ld �r�ll���(3 d'fir'��,t'�(1 1 <br /> ADDRESS 1ST F� Ll).2.5 ('; � �Aai � PERMIT/SERVICES <br /> PHONEFACSIMILE <br /> 1 <br /> TENTATIVE'APPOINTMENT DATE �� JU/ .� QpZ TIME <br /> (Please give 7 to 10 business days from dat of appf on s*+DYS <br /> al) <br /> CHECK BOX TO EXPEDITE REQ!Mr. 0 IV®� T�CES�N 11 B�AS 8 1 <br /> SIGNATURE OF APPLICANT DATE 6 �(�4 <br /> 1 <br /> FILE ADDRESS _ THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> SIO E . <br /> a c <br /> O(J ri.0 <br /> A/ Lf rrr.Lc <br /> v <br /> D tc� U L6 <br /> JUN <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) EJ HOUSING HOUSING ABATEMENT SOLID WASTE FACILITY <br /> 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 ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOIBODY PEIRCING ❑ POOUSPA - ❑ LAND USE APPLICATION STIES <br /> -MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 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 /> 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 /> 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 /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed the next business day. <br /> JNFIRMED APPOINTMENT DATE TIME ^ <br /> ATE CONFIRMED PHONE FAX INITIALS <br />