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r K_Ch_1 : NOA Environmental PHONE NO. : 209 369 4228 Dec. 03 2002 02:54PM P2 <br /> UAIkRFCENED_ _ <br /> EHO EOG NUMBER <br /> 1_' ,.0!JUAQU1N COUNTYPUBLIC HEALTH SE=RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC 0 3 2002 v 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 10(05 <br /> i.AVi-?()P41MEN l i IEALTH (209)468.3420 <br /> PF's11.^(T/SFR\/ICP.UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Id1813A 12AC-C-O r BUSINESS/AGENCY r4bA- :•NVI PONiMENTAL_ <br /> ADDRESS)) Z-Z-4r T,' )y�LS TU-)\J J IC A'U I <br /> PHONE t 7b!t 1"T�'� FACSIMILE (7-,09) 31 !q <br /> 0-2-S' <br /> TENTATIVE`APPOINTMENT DATE Imo-` )Z"6Z TIME 10 60 AVN, / <br /> (Please give 7 to 10 business days from date of application submittal <br /> CHECK BOX TO EXPEDITE REQUEST.$89.00 FEE-REQUEST PROCESSED IN 3 6U ll CLYS <br /> SIGNATURE OF APPLICANT ,� DATE <br /> FILE ADDRESS757�a THIS SIDE EHD STAFF USE ONLY <br /> L'�i PROGRAMELEMENTS SEARCH <br /> ' l�xq 1J•Gvi Avc..• f�s� N. G-v�ld . )^ ' ?.r .r :�.t .- _. <br /> ✓✓ 1 X2.4 `� <br /> ✓ o � udt. � -, <br /> W <br /> r <br /> ✓ 2( �. �4• !•.._. <br /> 133 E. 'r'v✓vu_..r Rct. ;, ) � _�.�_.r.. � ., � ,. .� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> 15R OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> RA UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> �O TIERED PERMITTED FACILITY 0 MOTELJHOTEL ❑ PUMPER TRUCKfYARD/CHEM TOILETS <br /> fJ TATTOO/BODY PEiRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM yR 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 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 filo is available. <br /> 4. Any fila 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 /> G. 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 />