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FROM NOR EnvironmentalPHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P2 <br /> do <br /> ( SAI� S'�QUIN COUNTYPU13LIC HEALTA' RVICES ` MID I,OCN1149Ep <br /> Via, ENVIRONMENTAL HEALTH DIVISION <br /> P_. '! 1304 EAST WEBER AVENUE,THIRD FLOOR <br /> pC C 2 3STOCKTON CA 95202 <br /> 2002 (209)488-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT lett l� BUSINESSIAGENCY refs, ct� <br /> ADDRESS <br /> D�S�Ort Lie �� G9 9.SZ�/o <br /> PHONE�LA31a7-37o1 �Ac//sIMILE� 4} 1a9—�fZZ$ <br /> TENTATIVE'APPOINTMENT DATE lO Z003 TIME / OD R I_a�� 7duy5 <br /> (Please give 7 to 10 buslrross days from data of apPllweon submittal) _�• <br /> CHECK BOX TO EXPEDITE REQUEST.$89.00 FEE-RE STP OCESSED IN 3 BUSINESS DAIW r <br /> 3 � <br /> SIGNATURE OF APPLICANT - DATE <br /> FILE AODRESS THIS SIDE EHD STAFF USE:ONLY <br /> PROGRAM IIFMENTS SEARCH <br /> d cA O <br /> rA <br /> IIU <br /> el„ � <br /> 3 S. <br /> L o <br /> 7 L <br /> a Lod; <br /> ec,4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> W UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> X UNDERGROUND TANK(MONITORINCIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOMODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM U OTHER(PLEASE SPECIFY ADO - <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) or mail to the <br /> or mail to the <br /> address indicated above. . <br /> 2. EHD will notify the applicant if any EHD Tiles 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 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 /> F <br /> CONFIRMED APPOINTMENT DATE TIME <br /> 1 DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />