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12/05/2002 12:10 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED EHD LW NUMUFR <br /> �r�i; ��� SANO-AQUIN CQUNTYPUBLIC HEALTH`RVICES <br /> R�,��s I�`�! �I ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 0 E C 0 5 ZOOZ STOCKTON CA 95202 <br /> (209)468-3420 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PIC %. Qdl/tula2d 40Fnt1140htPett� <br /> APPLICANT BUSINE55lAGENCY <br /> ADDRESS 237/^ Q O^^ (219J <br /> PHONE C.OS✓7�/y 7(� - 10 FACSIMILE -/0093,f AM/� . 93 <br /> � �S/TENTATIVE APPOINTMENT DATE ia11ol0A (reS)* TIME (,� <br /> (Pleasa give 7 to 10 business days from dale of application submittal) SeCC�r7 ` <br /> Uy <br /> IA! CHECK BOX TO EXPEDITE REQU T-$911.00 FEE REQUEST PROCESSIED IN J BUSINESS DAYS 1 r �jKcl{Fi <br /> SIGNATURE OF APPLICANA& fMAA�71DATE <br /> FILE ADDRESS <br /> r c <br /> r r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®}1 NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ®'OTHER CLEANUP SITE(NON-LOP) 1:1FOOD FACILITY I-) SOLID WASTE VEHICLE <br /> UOERGROUND TANK(MONITORINGIREMOVAL) El DOG KENNEL ❑ DAIRY <br /> A=DOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 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 ton (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 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 />