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�� SANOAQUIN COUNTYPU13LIC HEALT" <br /> ENVIRONMENTAL HEALTH DIVI� WG NUMBER <br /> NRVICES E"Y <br /> f v 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 468-3420 <br /> 4( <br /> PUBLIC RECORDS 9RELEASE AP TIO N <br /> PLICA � , <br /> TT <br /> APPLICANT -lam rt," v a V\ mu" BUSINESS/AGENCY Arc4P 1 9, pq92 <br /> ADDRESS CW1- L�� <br /> ZS�9 MxA 44 <br /> PHONE O9 <br /> -122( I <br /> FACSIMILE ZQ� S�' --�,ZS F <br /> TENTATIVE'APPOINTMENT DATE t( TIME <br /> 7r71�� <br /> (Please give 7 to 10 business drys from date of appllcat on submdtal) `� <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FE —4 REQUEST ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Cv�_� <br /> E `tll( 4Z <br /> FILE ADDRESS <br /> THIS SIDE EHD STAFF USE ONLY <br /> S` O'] S PROGRAM ELEMENTS SEARCH <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL SOLID WASTE VEHICLE <br /> Cl <br /> ❑ HAZARDOUS WASTE GENERATOR DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT i <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA <br /> ❑ MEDICAL WASTE FACILITY ❑ LAND USE APPLICATION SITES <br /> ❑ PUBLIC WATER SYSTEM ❑ <br /> 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 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 $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 will be processed the next business day. <br /> FCONFIRMED <br /> APPOINTMENT DATE TIME <br /> PHONE FAX INITIALS <br /> _ YES NO REVIEW DATE <br /> n iu niv — <br />