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12/05/2002 12:10 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECmEp <br /> rrSAN•AQUIN COUNTYPUBLIC HEALTH*RVICES ENDIWNUMBER <br /> \'f R ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> OEC 0 5 ZOOZ STOCKTON CA 95202 <br /> (209)468-3420 <br /> ENV R INMFNT HFALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMr <br /> APPLICANT � ` BUSINESS/AGENCYd peo!Cnul/DI1/���6 <br /> AO t) EBS Q 0 d CR <br /> 93 <br /> PHONE (02 4 9 - 106 FACSIMILEE y; -10 10 ,{M /E <br /> TENTATIVE'APPOINTMENT DATE ��//Q /iJ� UL0'5)* TIME .(IV /T/'• Za 'r /'rj/tfa,CE� , <br /> (Please give 7 to 10 buslnass days from dale of application submittal) selPUv`�' ` <br /> W(7h suWAMe, <br /> CHECK BOX TO EXPEDITE REQU T-SPI.00 FEE REQUEST PROCES DIN 3 BUSINESS DAYS r �1 �JJjQ�{IG1O <br /> SIGNATURE OF APPLICANT DATE I J Da <br /> FILE ADDRESS <br /> r c <br /> r r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®}INDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ®'OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ClSOLID WASTE VEHICLE <br /> hY OERGROUND TANK(MONRORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HZRDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ 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 , <br /> AN 00 T4 e1N3ge r_ ,. <br />