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12/05/2002 12:10 2094671118 AGE STOCKTON NAGE O1/O1 <br /> DATE RECEIVED <br /> [ �r�I n 1_ r SA*AQUIN COUNTYPUBLIC HEALTHI&RVICES EHD LOGNUM9ER <br /> (�sr �� [�) ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> OH 0 5 2002 ST02209)0468-CA 420202 <br /> ENv )NMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION �* <br /> PERM( <br /> APPLICANT ` BUSINESS/AGENCY-d�d 4oFnU1P011mp�.� <br /> ADDRESS ^ 00 d `IY <br /> PHONE (, 4DM 7(� - 166 FACSIMILE 00 t/10 "IO IV /I� <br /> TENTATIVE'APPOINTMENT DATE is/in* /(/� ( ((f�s TIME lal) / • , <br /> (Please give 7 to 10 buslnasa days from date of appliwUon Su6mlt[al) Se �lP <br /> s Saone, <br /> CHECK BOX TO EXPEDITE REQU T-S"00 FEE REQUESTPROCES DIN 3 BUSINESS DAYS / �JhQa'{,EO� <br /> SIGNATURE OF APPLICANTLr <br /> DATE / Da <br /> FILE ADDRESS <br /> rc <br /> r r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®}1 NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ur=OE <br /> "GROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> RDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY FORCING ❑ POOUSPA 0 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 /> 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 /> iH 00 � OtNL00 <br /> I <br />