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12/05/2002 12:10 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED EHD L00111111 <br /> r .�r� .II •; �((�� SAN &QUIN COUNTYPUBLIC HEALTH ?VICES <br /> nS ,(� r L� �/ L PQ ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> DEC; () 5 ZOOZ STOCKTON CA 95202 <br /> (209) 468-3420 <br /> DIVIR NMFNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERM( % hMd 4d FnUlr Mj <br /> APPUCAN7 ` \ BUSINESS/AGENCY <br /> ADtlR:3s �/y (J Q0 ( I•� /��/� <br /> PHONE `;0 / IV() FACS^^IMIL^E y; lU COQ^ /� <br /> TENTATIVE'APPOINTMENT DATE L /l/� trues) TIME <br /> (Please giro 7 to 10 business days from date of applic Ilan submittal) .fe <br /> LwR <br /> CHECK BOX TO EXPEDITE REQU T-Slim FEE REQUEST PROLES D IN 3 BUSINESS DAYS f 7hinkt <br /> SIGNATURE OF APPLICANT DATE / De� Vill <br /> FILE ADDRESS <br /> r c <br /> r r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®J,f NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ®,PTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> "IR" ERGROUND TANK(MONITORINGIREMOVAL) 13DOG KENNEL CI DAIRY <br /> HAYARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOL/SPA ❑ 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 END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any rile 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 , EI <br />