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Ll HJ <br /> At "IN COU <br /> ICES <br /> Ljj i L KL�;L-1 V L)-��1 �-,--7,+J <br /> t� -/' SAN SAN JO NTYPUBLIC HEALTH SE' <br /> JAN 0 1 21Jtl 0471RONMENTA'L HEALTH DINISIR711J <br /> 04 EAST WESER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> '3420 <br /> (209):468- <br /> Fc:RMI IC RECORDS RELEASE APPLICATION <br /> I <br /> APPLICANT BUSINESSIAGENCY nTA- Ko�-e <br /> ADDRESS <br /> PHONE 0 FACSIMILE. <br /> TENTATIVE-APPOINTMENT DATE )0 0 I TIME <br /> (please give 7 to 10 business days fr6m date of application submittal) • <br /> ( HECK BOX TO EXPEDITE REQUEST-$67.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS 11. <br /> U1 - <br /> C JAN -5 2001 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> V4 C I C,-n d 7 3 01 W. <br /> 23 040- 12 Moss a,lc)r, <br /> • <br /> 139 - 040. 0') Q0 usS C;o-- <br /> Z31 - 03a-01 L'i H 05S <br /> W LU1PMVAAUJ <br /> I -A <br /> iii 4f IrAhL A A &&91,L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE (LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> LI/OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY YSOLID WASTE VEHICLE <br /> g ND ERG ROUND TANK(MON ITORiNG/REMOVAL) C: DOG KENNEL 1:1 DAIRY <br /> AZARDOUS WASTE GENERATOR H 0 CHICKEN RANCH <br /> 13 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C3 <br /> T MOTEL/HOTEL 0 PUMPER TRUCKfYARDICHEM TOILETS <br /> LAND USE APPLICATION SITES <br /> CI <br /> 0 POOLISPA <br /> 0 TATTOOiBODY PEIRCING <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM M OTHER(PLEASE SPECIFY ABOVE) <br /> List up tot addresses in the space above. Select the ty0e(S) of files from the list above by checking <br /> the appropriate box(es). At least one file-ty' e MUST be selected. Fax to (209) 464-0138 or mail to the <br /> p <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD file's 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 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 /> 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 /> EK 00 14 03107100 <br />