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12/05/2002 12:10 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> r SAN QUIN GOUNTYPUBLIC HEALTH VICES <br /> Q I!1 ENVIRONMENTAL HEALTH DIVISI N <br /> 304 EAST WEBER AVENUE,THIRD FLOOR �qYg <br /> 95202 <br /> OEG Q 5 ZOOZ ST (209)46CKTON -3 20 <br /> (209)468-3420 <br /> ENv R NWNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> 1, t Qd liMd Geo Fnui�on 2lpit ( <br /> APPLICANT BUSINESSIAGENCY <br /> ADDRESS Q O ylh <br /> Q S ' <br /> /100C(PHONE C2D/y9 - uto FACSIMILE <br /> * Q <br /> TENTATIVE*APPOINTMENT DATE /A /0,9 (7UeS)* TIME .Vv #m ( ' <br /> (Please give 7 to 10 buslness days from date of applir Uan submittal) Se SUtPdr� <br /> Svwaylej <br /> CHECK BOX TO EXPEDITE RE T-541.00 FEE REQUEST PROLES D IN 3 BUSINESS DAYS l r 7}tand$ <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> r c <br /> r r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®�INDERGROUND TANK(UST)CLEANUP SITE(IOP) 13HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> �"0]'HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 6Y DE"GROUND TANK(MONITORINGIREMOVAL) 11 DOG KENNEL ❑ DAIRY <br /> a HXRDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <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 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 /> 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE . EI <br />