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I I M <br /> FROM : NOA Environmental <br /> UAIEKe1,�IvtU PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P3 <br /> SAN JTRUINCOUNTYPUB 0 E"°1,MNUMBER <br /> LIC HEALTH SERVICES <br /> i- f ���,� ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> 2 3 2002 STOCKTON CA 95202 j0qT <br /> (209)468-3420 <br /> ;;PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT /;Ls1+Q <br /> f '0 I BUSINESS/AGENCY <br /> ADDRESS 72 n _ l-�mVS�i.� <br /> PHONEy5 .x(07 <br /> FACSIMILE�Z09� 57&1 —Y z2-t� <br /> TENTATIVE"APPOINTMENT DATE ca T GD3 <br /> —� TIME �•r �'.� - l' -�3 /�r�/ <br /> (Please plve 7 to 10 business days from date of appllcatlon submittal) <br /> • <br /> CHECK 80X TO EXPEDITE REQUEST-58J9.pQEEI:-RE TP OCESSED 1N 3 BUSINESS DAYS Uhl <br /> SIGNATURE OF APPLICANT DATE <br /> J <br /> FILE ADDRr:SS THIS SIDE EHD STAFF USE!ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> I 8$D <br /> Vichr- P,8. 69 G/4 �+V V V �} <br /> iz 9001 'c4or -- <br /> 3 <br /> 5 q <br /> 0 -For <br /> b 5 LJ. CR V* <br /> Cl CA N4 M <br /> ,-are''e d?.� 00 <br /> ENVIRONMENTAL.HEALTH DMSION FILES veil f.9p+;C <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> sr OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> l;r UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> Ilir HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/C14EM TOILETS <br /> 0 TATTOO/BODY PEIRCING 0 POOUSPA o HND USE Appuc4mN SrrES <br /> ❑ 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),464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify tho 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 END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> e <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 11�tfiM'. - <br />