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12/05/2002 12:10 2094671118 AGE STOCKTON <br /> MTF RECEIVED PAGE 01/01 <br /> 1 SAN QUIN COUNTYPUBLIC HEALTHOVICES ED LOG NUMBER <br /> F11 F" ��I� [)! ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> I]E 4 0 5 2002 STOCKTON CA 95202 <br /> (209)468-3420 <br /> ENV R )NMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMf /' f Q <br /> APPLICANT ` BUSINESS/AGENCY 6POFnIJ//'p�')fnf1 � <br /> ADDRESS �t3 /� 00 l_iY <br /> PHONE CONT 7 ' �(J(,J -FACSIMILE <br /> _/ <br /> T � <br /> 'TENTATIVE*APPOINTMENT DATE � /�(/ 1paC (�ruaS TIME .(JC/ �ji• Q 1-6�c <br /> (Please giv0 7 1010 buslnesa days from date o!applicaUaO submI tai) Se !natej � <br /> lir SLI <br /> CHECK BOX TO EXPEDITE REQU T-M"R.00 FEE REQUEST PROCES D IN 3 BUSINESS DAYS `7M#40 <br /> SIGNATURE OF APPLICANT DATE Dc <br /> FILE ADDRESS <br /> r c <br /> r r <br /> 3 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®}INDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> &JOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> DE"GROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAYARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I. 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 revlew. 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 r <br /> EN 00 4 014=0 <br /> r s <br />