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SEP.25.2002L1;12:46PPP648.ARCA"T GERRGHTY&HILLER/JSP(RI MENTAL H N0.277 P.1/1• 02 <br /> eAlY aFg7VFfl � - . <br /> J SAN JO QUI COUNTYPUBUC HEALTH SERVICE � <br /> °N <br /> MENTAL HEALTH DIVISION <br /> �Oi $*''° `°' 44 STOCKTON CA 9AVENUE5202 ar . R` 0, 1111 <br /> D D (209)468-3420 `4W; <br /> '/ PUBLIC RECORDS RELEASE APPLICATION 2002 <br /> APPLICANT A/� I/OSG6 {- 9usINr=AOENCY !I4-R!_dflplS FNIVARUNWNT FAITH <br /> AODRESs o O iu <5'v�— PERMIT/SERVICES <br /> PHONE 6s'/o 23;d�, tNTIMNT <br /> o FAcsnnlLE Csro� 233 - �7� K lw <br /> r a A DATED 7 TIME <br /> 'A iJ s,.7 (Please owr 7?rtA <br /> f t�e1 11eeUon submittaq <br /> CHECK 907(TO EXPEDITE REQUEST- 0PR SED I S DIUSINE35 DAYS <br /> SIGNATURE OF APPLICAN / DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF 459 ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> 204-1 I'j66U <br /> t, <br /> N <br /> OU ll Li LI <br /> l8 L, L L, <br /> 2 O <br /> it It It _ <br /> VVU <br /> O <br /> 5 Lt <br /> 2 <br /> E('.�110A ` -1.5-02.. <br /> NVIRONM6NTAL HEALTH DIVISION FILES <br /> RGROUNO TANK(UST)CLEANUP SITE(LOP) D HOUSING ASATEMENT 13LID SOWASTti FAC <br /> yNPEILITY <br /> PTlt 11 CLEANUP SITE(NON-LOP)OP) ❑ POOP FACILITY 4 SOLID WASTE VEHICI It 3� 7u02 <br /> UNDERGROUND TANK(MONITORING)REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 4 CHICKEN RANCH , L7 PKO TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTLLIROTEL ❑ PUMPERTRUCKMARI3ICHEM TOq.ETS <br /> ❑ TATT•OOIDODY PEIRCMG ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> d MEDICAL WASTE FACILTY CI PUBLIC WATER SYSTEM ❑ OTHER(PLEASE 6PECIFY ABOVE) <br /> 1. List up to ton addresses in the space above. Select the types) of flies from the list above by checking <br /> the appropriate box(es). At toast one file type MUST be selected. Fax to (209)464-0138 or mail to V30 t <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 beheld 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 some applicant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointmont 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 /> i <br /> REVIEWED YES NO REVIEW DATE <br /> pr <br /> I <br />