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\ 03/21/2002 17:25 2094671118 AGE STOCKTON EPGE 01/01 <br /> \/ u <br /> GATE RECEIVED <br /> SAhOAQUIN CUUNTYPUBLIC HEALTH�RVIC <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON 9 ` <br /> 13 <br /> (209)468-3-3 4200 <br /> UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT n BUSINESSIAGENCY <br /> ADDRESSn1 //��(d /// QQdo /y l <br /> PHONE a49) 7 � � FACSIMILE02 V/d <br /> / <br /> TENTATIVE*APPOINTMENT DATE <br /> arl /t?areh ZQf TIME /��Qd Mf'IR 2 1 7002 <br /> (Please giv 7 10 business day from to or Plical' n submittal) li „L_I. <br /> � VI s� � N %iii:. ( HEALTH <br /> CHECK BOX TO EXPEDITE REQUE - 0.00 FEE-REQU S PRO S D BU ESS DAYS <br /> SIGNATURE OF APPLICANT LL DATE pr-f <br /> FILE ADDRESS <br /> � Q K <br /> it <br /> i F/ <br /> 5� • S ad us � <br /> 51) 7t rbr� <br /> S7. <br /> .oma mor use P MAa F �r:ro <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT X. SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRUGK/YARDICHEMTOILE75 <br /> ❑ TAlT00lBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICAT10N SITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O 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 (200) 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 file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD stall 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 EHD 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 99 14 01M Q <br />