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2094671 AGE. STOCKTON PAGE 02 <br /> SAN JCs,,tUIN COUNTYPUBLIC HEALTH SF 'ICES <br /> ENVIRONMENTAL HEALTH DIVISIOr�' <br /> OCT 1 8 2000 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> - • <br /> E (209) 4"-3420 <br /> HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT USINES5IA,EN,Y <br /> ADDRESS 4A90 5 w1hign <br /> PHONE Q D FACSIMILEr /0 1 <br /> TENTATIVE*APPOINTMENT DATE�sA-'�? TIME _—..g <br /> '0 Q ra <br /> (Please give 7 to 10 business days from date of application submittal) <br /> Il CHECK BOX TO EXPEDITE REQUEST-$78.0 EE--RE EST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1e ri- DATE (904—L ;I'0D a <br /> w <br /> FILE ADDRESS <br /> �✓ /{r <br /> 114!4* a ' i �, -{ --. . <br /> r- - .14= <br /> I. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> W( UNDERGROUND TANK(U$T)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> L`d UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL M DAIRY <br /> IR HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMr-NT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL M PUMPEk TRUCKtYARDICHEM TOILETS <br /> 0 TATTOOISODY PEIRCING <br /> POOLJSPA n LAND U'SE APPLICATION Sl-MS <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM n OTHER(PLEASE SPECIFY ABDVl=) <br /> 1. List up to ten addresses in•thei 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(20$1464.--0138 or mi3it to the <br /> address indicated above. <br /> Z EHD will notify the applicant if any F-IfD 11106 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 /> EH 00 14 01MAN <br />