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FROM : NOR Environmental PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P3 <br /> u IE Re�eJVEU EHD 4oc NUMBER <br /> _ SAN Jt, QUIN COUNTYPUBLIC HEALTH SERVICES <br /> P ENVIRONMENTAL HEALTH DIVISION <br /> W 304 EAST WEBER AVENUE,THIRD FLOOR 107T OL-C 2 3 2002 STOCKTON CA 95202 <br /> (209)466x420 <br /> ;PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1 / L OW)/eLl BU5INESSIAGENCY_(_�t,DA (icravwa2 � <br /> ADDRESS 22 n(. <br /> PHONE &C 5)367-3`76 ( -FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE b ZG83 TIME /'��'v._ I_2�3 ���`'1�✓ <br /> (Please give 7 to 10 business days from date of appllcatlon submittal) 1� <br /> CHECK BOX TO EXPEDITE REQUEST•S E-RE T P OCESSED IN 1 BUSINESS DAYS Uh• 50 <br /> SIGNATURE OF APPLICANT DATE 12 Z" O Z <br /> FILE AbbRESS THIS SIDE EHD STAFF USP ONLY O <br /> PROGRAM ELEMENTS SEARCH <br /> S80vict6r lid, L,d GA V V v V <br /> '1k13 1 <br /> —2 9001 c(Or _ p p <br /> 31011 I <br /> 70 dnrd. %4 'V 1r ^ <br /> a 5 1- cA _ r �M/ <br /> re dors <br /> W <br /> ue11 tSeP ;� -trr pc.-w.i`fs <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> M'OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ff UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IIS HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUMOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> d TATTOO/BODY PEIRCING El POOUSPA O LAND USE APPLICATION SITES - <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM P 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(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 Nle 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 $89.00 deposit prior to review. <br /> 51 *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 />