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'SEP. <br /> WT!.25.2002L1;1246PM16g8•P AD IS GERRGHTY&MILLERiJSR:R0I�IMEIVT'gLTH N0.277 P.1 02 <br /> WXNED <br /> SAW iOAQUIIJCOUNTYPUBUG HEALTH SERVICE � �t <br /> N1 NMENTAL HEALTH DMSIION <br /> 4,1 0016 me, a <br /> STOCKTONCA95 02 �4R_` <br /> O D (209)488-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION 2002 <br /> APPLICANT 4SC-0BUSINESSIAOENcY A794A'6IS _r-wun I-INMFNT.HEAITH <br /> MDRess /05-0 <br /> r LLtr PERMIT_ <br /> /SERVICES <br /> PHONE �slc) 233-3200 FACSIMILe ' ePv) Oft <br /> 'TENTATIVP.APPoiNI MENTDATE TIME: <br /> (Pleeae give 710 I D �sa r ��IleeUon submittal) <br /> i(DDX' FJCPEDP.iE R(:QUEST- - —QU�EST <br /> —PRO <br /> �E EDI ]BUSINESS DAYS <br /> SIGNATURE OF APPLICANT( DATE <br /> FILE ADDRESS TNlti SIDE END STAFF USI:ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> (9 IF 11 <br /> t7U It Li LI <br /> ✓2 I q Li . . . <br /> 12 4 LL L, <br /> O k u ti <br /> It <br /> S Li <br /> O <br /> - // c -.Z5 02_ <br /> 'ENVIRONMENTAL HEALTH DIVISION FILES <br /> yNPERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING A6ATUFNT O BOLha WASTE FACILITY <br /> rTHER CLEANUP SI E(NWLOP) ❑ FOOD FACILITY CI SOLID WASTE VEHICLE <br /> UNDERGROUN0TANK(MONIToRINGLREMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> ❑ TIEWM HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br /> U PKO TREATMENT PLANT <br /> 0 TIERED IRODY TFA FACILITY O F OTEI.AHOIEL C3 PUMPOVI'AUCKIYAROIC"EM p LAND USE APPLICATIONN SIMS bkLETS <br /> Q TATTOD1e0DY PEIRCINO � A POOLISPA <br /> ❑ MEDICAL WASTE FACILITY d PUBLIC WATER SYSTEM ❑ OTHER.(PLEASE SPECIFY AROVE) <br /> 1. List up to tan addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es).. At lust one file type MUST be selected. Fax to (2091464.0138 or m iia to VA r <br /> address I�icated above, <br /> 2. EHp will Hotly 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 hold for a maximum of five business days for review..Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being warlied on by EHD staff may not be Immadlately 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 sante applicant may require a$88.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applieakions recofved after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE.^ _ TIME <br /> .:r <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> i <br /> REVIEWED YES NO REVIEW DATE <br /> A 10 <br /> pr <br /> � I <br />