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FR6M NOR Environmental PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P2 <br /> SAN -rWAQUIN COUNTYPU13LIC HEALTH SERVICES Elio SOcuuwDt <br /> ENVIRMENTAL+ Iw Irr 304 EASTJW BER AVENULTHIRD FLOIOR <br /> STOCKTON CA 95202 I D <br /> Dt 0 2 3 2002 (209)468-3420 91 <br /> Oik,;,,vF,, PUBLIC RECORDS RELEASE APPLICATION <br /> ILI I1 <br /> APPLIC/WT BUSINESS/AGENCY� U�r'on � <br /> ADDRESS -- <br /> PHONE LP--0 9 334,-7-3701 FAC//SIMILE(! MScor`gZZ8 <br /> TENTATIVE'APPOINTMENT DATE � TIME l OD Q, -a-�ild5 <br /> (Pleaso 91ve 7 to 10 bmin s days from data of 7PPile lion submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST•$09.00 FEE-RE STP OCESSED IN 3 BUSINESS DAH <br /> SIGNATURE OF APPLICANT - DATE It <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEIdENTS SEARCH <br /> a A <br /> Ito <br /> 4 If 5p <br /> 3 <br /> 144 <br /> (/ O <br /> T z �. O <br /> 61 � <br /> 1 � � dAlln <br /> cs T <br /> utl �st P""" S <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> F7 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Rf UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> Ir HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARWCHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLfSPA O LANG USE APPLICATION SITPS <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM N OTHER(PLEASE SPECIFY ABO <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(2091464-0138 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 an 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 /> r <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> l <br /> I REVIEWED YES NO REVIEW DATE <br />