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L'--t, lUT CREEK U902/002 <br /> 07/22/£ne:eb:00 4640138 ENVIR04ME NTAL HEALTH PAGE 01 <br /> o/•..• �. ."Sec N1b.®IIt <br /> • N X&UIN COUNTYPUBLIC HEALTH SWICES <br /> ENVIRONMENTAL HEALTH DIVISION :L9304 EAST WEBER AVENUE,THIRD FLOOR �" <br /> STOCKTON CA 95202 <br /> (209)46fls420 <br /> �URLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ----------------- <br /> I L1'-LMP` L BUSINESSIAGENCY Vkc-kon Sc,l ��i0✓ls, �(,t>,C <br /> ADDRESS_15--15 Tre_o..i- �)yd I W a I Y��� lam.� CA �y 3 q G of t' <br /> PHONE 3'1..rJ —Ci-1 FACSIMILE <br /> TENTATIVE'.APPOINTMENT DATE -30 Z)2 TIME _ I D: OD Avv% <br /> (Please fire 7 to 10 bualnass date or a IC2&1 r auhmlU21) �v <br /> G�iV/TS <br /> CHECK BOX TO E(PE01T1:REQUEST-S89,amo FF,$-REQUE • S�®BUSINESS DAYS • <br /> SIGNATURE OF APPLICANT Q DATE <br /> 7 <br /> - till <br /> nLE ADDRESS THIS SIDE EHD STAFF USE` Y' 3 2002 <br /> ` PROGRAM ELEMENTS S 04 <br /> 22^^1^ I, - '% <br /> q t Vd . <br /> ert� S <br /> Vy 32 S. rnIC, i <br /> 50TITM <br /> W. rrn o n kD el <br /> :n.a ol LI, <br /> Ivaw <br /> n <br /> Vt 0o1 M, vc <br /> ENVIRONMENTAL HEALTH DIVISION FILES V/ <br /> /y UNDERGROUND TANK(1-1911 CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY,,., <br /> ]g OTHER CLEANUP SRE(NON-LOP) ❑ FOOD FACILITY ❑ SOLM WASTE VEHICL5i,,`- <br /> UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNFL ' 0 DAIRY ' <br /> �� HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PL%.,tl{x <br /> 299Q„ TIERED PERMITTED FACILITY l7 ICO'TFLINOTEL 0 PUMPER TRUCKIYARf AEM TOILETS <br /> ❑ TATTOOInOnY PEIRCING ❑ POOUSPA O LAND USE APPLCATfW SrrE9 <br /> U ME0ICAL WASTE FACILITY ❑ PUOUC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the typa(s) of files from the list abode by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0118 Pk mail to the <br /> address Indicated above. "1 <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be 68�Ormed <br /> approximately five business days but no later than tan (10) days after receipt Of appllcaNn. The files <br /> will he held for a maximum of five business days for review. Appointments should be sdliteduled <br /> accordingly. f <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available fo�oviow. A new <br /> application mai/be submitted.when the file Is ava0able, <br /> 4. Any file not returned In the same condition as released will be reorganized by END 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 /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm wilt be processed the next business day. <br /> , <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> h ni.por <br />