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MARCUS H. BOLE ASSOC S30 633 0119 09/22/03 02:sspm P. 0101 <br /> �j; SAS-jAQUIN COUNTYPUBLIC HEALTH SE17VICES •'ILOGHUMMER <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 2 2 2003 STOCKTON CA 95202 <br /> (204)468-3420 <br /> -i,\ !hi wlv EN Ir HEAL1 H PUBLIC RECORDS RELEASE APPLICATION <br /> I'PRRM,1T,'� <br /> APPLtCAN7 J (:(/S C6BUSINESS/AGENCY <br /> ADDRESS �J�I GtJ A G <br /> PHONE 536 FACCSIMIILF. -3 �/I <br /> TENTATIVE'APPOINTMENT DATE /[ SA 10 —TIMES -K a 5CF10— 3 007 <br /> (PloasR QJ-R T to 10 buclnacs Crays from dal*of appltcatton svbmlllal) S <br /> CHECK BOX TO EXPEDITE REQUEST•189.00 FEE-REQUEST PROCES O IN J BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �) <br /> DATE <br /> FILE ADDRESS THIS SIDE CHO STAFF VSE'ONLY <br /> QPROGRAM ELEMENTS SEARCH <br /> // FNVIRONMENTAI. HEALTH DIVISION FILES <br /> ✓UN <br /> LDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ADATEMENT O SOLID WASTE FACILITY <br /> D OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> B-DNOERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> PHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOO/BODY PEIRCING O P004-/5PA CI LAND USE APPLICATION SITES <br /> D MEDICAL WASTE- FACILITY ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(cs). At least ono filo type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. END 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. Appointmonts 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$89.00 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 />