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05/11/2002 09:17 FAX 209 948 0621 RLEINFELDER 002/002 <br />EHG LOG NUMBER <br />OATS REC D <br />SAN 41WQUIN COUNTYPUBLIC HEALTHVICES <br />�I1 V! ENVIRONMENTAL HEALTH DIVISION71#3 <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209)468-3420 <br />021-1hIR I/I �� I�ABLIC RECORDS RELEASE APPLICATION <br />APPLICANT^� / '�6LyG� BUSINESS/AGENCY KI'e""iere ld-er <br />ADDRESS : ZZ A ` �✓I r-'J"I"C S-}�c J- p <br />PHONE �— �34�5 FACSIMILE <br />TENTATIVE" APPOINTMENT DATE L���� TIME �d <br />to 10 <br />tress a�� to of plication subml[tap <br />CHECK BOX TO EXPEDITE . F RE S IN3 BUSINESS DAYS <br />DATE <br />SIGNATURE OF APPLICANT y <br />��JsoarG�� <br />PROGRAM ELEMENTS SEARCH <br />35 P'M: n r fl. CL ,L ie� NUL 1 <br />� E 6 ,er AV S�ck�-e.• Ca . <br />E��fof44o- CA <br />- Mira ie Sf. S*e 4Fe+ c4 <br />D335 i✓: er S� 5'IcH' Ca <br />�j/ jUoZ �j G -M %r�FP S'/' ��ekto., cfi <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />sI'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT iG SOLID WASTE FACILITY <br />.0OTHER CLEANUP SITE (NON -LOP) <br />El FOOD FACILITY .127 SOLID WASTE VEHICLE <br />❑ DOG KENNEL 13 DAIRY <br />.Cr UNDERGROUND TANK ORINGIREMOVAL) ❑ CHICKEN RANCH 13PKG TREATMENT PLANT <br />RC HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKrrARDICHEM TOILETS <br />.El TATTO PERMITTED FACILITY ❑ POOVSPA ❑ LAND USE APPLICATION SITES <br />❑ TATT00L WAS PEIRC FACILITY <br />❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />)a' MEDICAL WASTE FAGILffY <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 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 he processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />