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12/05/2002 12:10 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED EHD 106 NUMBER <br /> / SAN &QUIN COUNTYPUBLIC HEALTH19RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 0 E C 0 5 2002 STOCKTON CA 95202 <br /> (209)468-3420 @� <br /> ENV1RQNMFNT HFALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PPLIC <br /> /, t AlMed Geo F1)9"AeA1IZ Q <br /> APPLICANT ` J BUSINESS/AGENCY <br /> ADDRESS <br /> PHONE Cao4 ADO FACSIMILE /y� ID �,(� //�� fe TENTATIVE APPOINTMENT DATE �Oa�-ues) TIME .1 0 'fm ��y, j(Please give 7 1010 business day9 from dale of appliwUon Submittal) ose smock" ` <br /> 4� CHECK BOX TO EXPEDITE RE T-591,00 FEE RECIUESTPROCES DIN 3 BUSINESS nAYS / "J/1KIfFiO <br /> SIGNATURE OF APPLICANT DATE / Da <br /> FILE ADDRESS <br /> U41 1+ <br /> r c <br /> r r <br /> I <br /> CI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®JINDERGROUND TANK(U5T)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> FJOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> �DERGROUND TANK(MONTTORINGIREMOVAL) C] DOG KENNEL O DAIRY <br /> HZGYRDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMUTED FACILITY ❑ MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOUSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM CI 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$78.00 deposit prior to review. <br /> S. `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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 1114 00 14 01 e G l', m <br />