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02/04/02 MON i6:D8 FA.& 209 94Y U21 KLEINFELDEX <br /> EN <br /> ADAM MQnVEO D LOG NUMBER <br /> SAN JO,-'4t111N COUNTYPUBLIC HEALTH SERAIES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> I71 -;j(•;i._ I '='•.i. i��Ai.I II STOCKTON CA 95202 <br /> - <br /> ._.. (209) 468-3420 <br /> 02 FEIL-5 am a: olf--7 UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTr �•�• 1� ��`�Q�v��' 13USINESSIAGENCY <br /> ADDRESS 2�a.� E /'`l �fl•c S��fo^ G/� qs�5 <br /> PHONE qy�^ 13 �S FACSIMILE �q2 —DC 2 t <br /> TENTATIVE'APPOINTMENT DATE �////0� TIME <br /> (Please 7 t7 to 10 business days fran(Age of application submittal) <br /> I] CHECK BOX TO EXPEDITE REQU EST-587.00FE�QUE;ReC A IN*UUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DATE <br /> FILEADDR ESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> f M ;,f-r 4vc - -- rlc,Fo� 6a as <br /> W <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 173 FOOD FACILITY 11 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH M PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY l7 MOTELIHOTEL ❑ LIMPER TRUCK/YARDICHEM TOILETS <br /> CI TATTOOIBODYPEIRCING 0 P60USPA 'VLAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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) 464-0 38 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 hold 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 flle 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 />