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FROM NOA Environmental PHONE N0. 209 369 4228 • Dec. 23 2002 12:24PM P3 <br /> UAIa KeLF.1Vlu <br /> SAN J AQUIN COUNTYPUBLIC HEALTH SERVICES 1 EM 400 NUMEER <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR j0qT <br /> DEC 2 3 2002 STOCKTON CA 95202 <br /> (209)465-3420 <br /> �kT:u il;;v;c;:; "'PgBLIC RECORDS RELEASE APPLICATION <br /> ry. <br /> APPLICANT .G/'L I`C'OW)eZ.l BUSINESS/AGENCY�&I,Ort <br /> (r�ror�wi,r_SI� _ <br /> ADDRESS ZZ A _ f-fOUS .� l - . ; "e /q 557-g6 <br /> PHONE&05 -.3 d 1 FA//CS IMILE_(Zb9) 3Y&j Z.7-IT <br /> TENTATIVE'APPOINTMENT DATE_� , 7-46. 3 <br /> TIME q'�G�ry, (_ 3 7 /fir 1 <br /> (Please plve 7 to 14)business days from date of application submlHal) &Z-405 <br /> CHECK BOX TO EXPEDITE REQUESTS�E-RE TP OCESSED IN 3 BUSINESS DAYS Uh <br /> SIGNATURE OF APPLICANTZr DATE 12- Z O Z <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ] I WVicftr ✓7C(. i cc(; GA T <br /> 1 9001 'char <br /> 3 Nn f ' <br /> 5 <br /> ' 2 <br /> -7 h. <br /> .,•_ <br /> 5 � 1 C4CL <br /> n <br /> iL <br /> r ,,.,are ck<9.5 .. <br /> cell tStp %c pe,-IwstS <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 10 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Mr OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ff UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> d TATTOOIBODY PEIRCING O POOVSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 91 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 ton(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$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 /> N <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />