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FROM : NOA Env f ronmen•ta 1 'i I <br /> uwieRe�r.Fvtu l�E NO. 209 3S9 4228t `' Dec. 23 2002 12:24PM P3 <br /> It EHD%OC NUMBER <br /> SAN AQUIN COUNTYPUBLIC HEALTH,WRVICES t <br /> ENV EALTH DIVISION <br /> ,.. lRONMENTAL H Q ` <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ZOOZ <br /> STOCKTON CA 95202 ; I Oqtr <br /> (209)4138=34201 f <br /> . BL1C RECORDS RELEASE APPLICATION <br /> APPLICANT L or��e� 1. BUSINESSIAGENCY ! ,r c2y% «K ( <br /> ADDRESS ZZ - 5 .. LA G,' .J Z yG 11 <br /> PHONE&00 —3 7.0 1 FACSIMILE 4/Z.2Ir <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please piva 7 to 10 bullnass days fmm date of application submittal) r w <br /> 1� I <br /> CHECK BOX TO EXPEDITE REQUEST-SE RE T P OCESSEI,IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � �y v Z_ M <br /> FILE ADDRESS if THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> . I M is rPd,. L.�d: GR T ;l II <br /> z 9i')Q y c4or <br /> 3 <br /> -7 <br /> ` '1 <br /> 3 ,veli s ;Llsrrvs <br /> 5 � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> » UNDERGR00N1)TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ,s ❑ SOLID WASTE FA <br /> Mr OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY I� 11;17 SOLID WASTE V <br /> M UNDERGROUND TANK(MONITORIHGIREMOVAL) ❑ DOG KENNEL Q DAIRY <br /> ' HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH I �I7 PKG TREATMEN <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL I O PUMPER TRUCK/ OILETS <br /> ` ❑ TATT0019ODY PEIRCING ❑ POOLISPA �j ;IO LAND USE APPLI <br /> f 17 MEDICAL WASTE FACILITY s ❑ PUBLIC WATER SYSTEM I 'lid OTHER(PLEASE VE) <br /> i <br /> 1. list up to ten addresses in the space above. Select the type(s) of�[iles 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 mai)to the <br /> address indicated above. If I <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) "ays 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. l} 1� <br /> 3. A file that Is actively being worked on by END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. i i'M <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 appllcant may require a$89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be Confirmed with EHD staff: <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> - - <br /> DATE CONFIRMED .-PHONE FAX -INITIALS <br /> REVIEWED YES NO -REVIEW DATEi� <br /> I <br /> }� 10 <br /> �. 1 <br />